Systems, devices, and methods for mechanically reducing and fixing bone fractures

ABSTRACT

A frame is sized and configured to support a reduced bone fracture of an individual. A guide assembly on the frame carries a bone fixing device guide that defines a guide path along which a bone fixing device can be advanced into a region of the reduced bone fracture. A linkage system couples the bone fixing device guide to the frame for articulation of the guide path among a plurality of desired orientations with respect to the reduced bone fracture. A guide bushing is included. Which includes packaging that maintains the guide bushing in a sterile condition prior to insertion into the bone fixing device guide.

RELATED APPLICATIONS

This application is a continuation-in-part of co-pending U.S.application Ser. No. 13/051,774, filed on Mar. 18, 2011, which claimspriority to of U.S. Provisional Patent Application Ser. No. 61/443,080,filed Feb. 15, 2011, entitled “Systems, Devices, and Methods, forMechanically Reducing and Fixing Bone Fractures,” which is incorporatedherein by reference. This application also claims the benefit of U.S.Provisional Application No. 61/396,562, filed May 28, 2010, entitled“Apparatus and Method for Reduction and Stabilization of BoneFractures,” which is incorporated herein by reference.

FIELD OF THE INVENTION

The invention generally relates to systems, devices and methods forreducing and fixing bone fractures.

BACKGROUND OF THE INVENTION

Bone fractures can occur in various regions of the body, and affect bothchildren and adults. Bone fractures can occur, e.g., in the arm,involving the humerus and/or forearm and/or wrist; in the leg, involvingthe tibia and/or fibula; or at, in, or near articulating condyles (alsocalled a condular fracture), e.g. at, in, or near the elbow, or at, in,or near the knee.

Under some circumstances bone fractures may require more intensivetreatment than simple immobilization. For example, due to the severityof the fracture, certain bone fractures may require surgical reducingand fixing, including placement of pins, screws, or other fixationdevices, which must be precisely positioned to ensure that the fractureis properly reduced (i.e., aligned) and fixed during recovery andhealing.

By way of example, several different treatment options exist forcondylar fractures above the elbow, called supracondylar fractures. Asupracondylar fracture is shown in FIGS. 7 and 8. Supracondylarfractures are relatively common in children, and may occur for example,when a child falls onto an outstretched arm. Fractures of this type maybe classified according to the degree of fracture region separation,with the resultant treatment being predicated upon the fractureclassification.

For example, Type 1 fractures are un-displaced or minimally displacedfractures, such as hairline fractures and are treated with simpleimmobilization in a cast without any manipulation. Type 2 fractures arepartially displaced such that the regions are nearly aligned, with somebony contact present. This type is typically treated by manipulationfollowed by immobilization in a cast. Type 3 fractures (see, e.g., FIGS.7 and 8) are completely displaced with fracture regions far apart fromeach other.

In known methods for treating type 2 and 3 fractures (see FIGS. 1 to 3),the current standard of care is, by manual manipulation of the arm (seeFIG. 1), a surgeon attempts to return the fractured bone regions to ananatomically normal alignment, which can also be called “manualreduction.” Following manual reduction, the fracture is “fixed” (seeFIG. 2), during which the surgeon will hold the manually reduced boneregions in place and insert pins or other fixation device, whilechecking radiographs to verify pin placement, to prevent the manuallyreduced bone regions from moving out of alignment during the healingprocess (see FIG. 3).

In the current standard of care, both manual reduction and fixing areperformed “free hand” with the aid of radiation imaging. The currentstandard of care is, at best, problematic in several respects. First, byfree hand manual manipulation, the surgeon can at best only approximatea complete anatomic reduction of a complex fracture in all anatomicplanes. Manual reduction competes against itself: manually bringing thefracture into alignment in one anatomic plane, can move the fracture outof alignment in another anatomic plane. Second, the surgeon must by freehand manual manipulation attempt to hold the free hand reduction inplace, while also in a free hand fashion simultaneously insert the pinsto fix the reduction. A loss of manual reduction, imperfect to beginwith, occurs. As a result, the current standard of care is frequentlyinaccurate, with patient injury resulting from incomplete reduction.Third, the repeated radiation imaging of the fracture during manualreduction and pin placement process exposes both the patient and thesurgeon's hands again and again to radiation.

While the traditional manual treatment method is effective in someinstances, exposure of the fracture through an open incision is oftenrequired. Such treatment is invasive. Further, operative time for thesedifficult to treat fractures may become lengthy and exceed seven hours.

Due to the obvious risks involved, improvement in manual fracturereduction and fixation is desired.

SUMMARY OF THE INVENTION

The invention provides devices, systems, and methods for mechanicallyfixing bone fractures, simple or complex, in children or adults, andinvolving all bone types, including, e.g., in the arm, involving thehumerus and/or forearm and/or wrist; in the leg, involving the tibiaand/or fibula; and at, in, or near articulating condyles (also called acondylar fracture), e.g. at, in, or near the elbow, or at, in, or nearthe knee.

According to one aspect of the invention, the devices, systems, andmethods include a frame that is sized and configured to support areduced bone fracture of an individual. The devices, systems, andmethods include a guide assembly on the frame including a bone fixingdevice guide that defines a guide path along which a bone fixing devicecan be advanced into a region of the reduced bone fracture. The guideassembly includes a linkage system that couples the bone fixing deviceguide to the frame for articulation of the guide path among a pluralityof desired orientations with respect to the reduced bone fracture. Thedevices, systems, and methods also include a guide bushing having aninterior channel for passing a bone fixing device. The guide bushing issized and configured to be handled separate from the guide assembly forinsertion into the guide path of the bone fixing device guide at theinstance of use and for separation from the guide path after use. Thedevices, systems, and methods also include packaging that maintains theguide bushing in a sterile condition prior to insertion into the guidepath. The modular, sterile guide bushing makes possible the sterileinsertion of a bone fixing device using the mechanical guidancemechanism, without the need to sterilize the entire mechanical guidancemechanism.

In one embodiment, the interior channel of the guide bushing includes anentrance end for receiving the bone fixing device for passage. Theentrance end comprising a funnel shaped entrance surface that directsthe bone fixing device directly into the interior channel. In thisarrangement, the funnel shaped entrance surface shields contact with theinterior channel prior to use.

The guide bushing can be disposable, or the guide bushing can bereturned to a sterile condition and repackaged after use.

In one embodiment, the linkage system of the guide assembly includesfirst and second links. The first link articulates the bone fixingdevice guide in a first plane, including a mechanism that is sized andconfigured to mechanically interact with the first link to maintain adesired articulation in the first plane. The second link articulates thebone fixing device guide in a second plane different than the firstplane, including a mechanism that is sized and configured tomechanically interact with the second link to maintain a desiredarticulation in the second plane without altering the desiredarticulation in the first plane. In one embodiment, the linkage systemincludes a third link that articulates the bone fixing device guide in athird plane that intersects one of the first and second planes at anangle. The third link includes a mechanism that is sized and configuredto mechanically interact with the third link to maintain a desiredarticulation in the third plane without altering the desiredarticulations in the first and second planes.

According to another aspect of the invention, the devices, systems, andmethods further include at least one fracture reduction mechanism on theframe that is sized and configured to apply at least one mechanicalforce vector to maintain the reduced bone fracture in at least onedesired anatomic orientation during articulation of the guide path ofthe bone fixing device guide. In this arrangement, the frame carriesboth a fracture reduction mechanism and a fixing guide assembly toachieve systematic mechanical reduction and fixing of the bone fracture.

According to another aspect of the invention, the devices, systems, andmethods further include an orthotic brace that is sized and configuredto be fitted on the frame to a region of the reduced bone fracture.

In one embodiment, the invention provides devices, systems, and methodscan be applied for mechanically fixing a fractured supracondylar regionfollowing a reduction.

Other objects, advantages, and embodiments of the invention are setforth in part in the description which follows, and in part, will beobvious from this description, or may be learned from the practice ofthe invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1 to 3 illustrate prior art manual reduction and fixation of abone fracture.

FIG. 4 is an anatomic view of a human torso, showing the supracondylarregion of the right arm.

FIGS. 5 and 6 are, respectively, an anterior and a posterior view of thesupracondylar region and adjoin bone structures in a right human arm.

FIGS. 7 and 8 are, respectively, an anterior and a posterior view ofbone structures in the right human arm, like that shown in FIGS. 5 and6, but also showing a supracondylar fracture, showing left-rightdisplacement of the proximal and distal bone regions of the fracture.

FIGS. 9 and 10 are medial views of the supracondylar fracture shown inFIGS. 7 and 8, FIG. 9 showing an anterior-posterior displacement of theproximal and distal bone regions of the fracture, and FIG. 10 showing arotational displacement of the proximal and distal bone regions of thefracture.

FIGS. 11A and 11B are, respectively, a top view and a right side view ofan individual in a prone position, with the humerus and forearm of theindividual orientated in a manner conducive for reducing a typicalsupracondylar fracture of the right arm, and also illustrating theprincipal anatomical reduction axes for the supracondylar fracture.

FIGS. 12A to 12D are anatomic and partially schematic views of a righthuman arm with a supracondylar fracture, demonstrating the applicationof a force reduction vector comprising distal traction.

FIGS. 13A to 13D are anatomic and partially schematic views of a righthuman arm with a supracondylar fracture, demonstrating the applicationof a force reduction vector comprising superior traction.

FIGS. 14A to 14D are anatomic and partially schematic views of a righthuman arm with a supracondylar fracture, demonstrating the applicationof a force reduction vector comprising lateral translation or traction.

FIGS. 15A to 15D are anatomic and partially schematic views of a righthuman arm with a supracondylar fracture, demonstrating the applicationof a force reduction vector comprising varus/valgus rotation.

FIGS. 16A to 16D are anatomic and partially schematic views of a righthuman arm with a supracondylar fracture, demonstrating the applicationof a force reduction vector comprising pronation/supination rotation

FIGS. 17A to 17D are anatomic and partially schematic views of a righthuman arm with a supracondylar fracture, demonstrating the applicationof a force reduction vector comprising flexion/extension rotation.

FIGS. 18A and 18B show, respectively, top and side views of an exemplarysystem sized and configured for achieving a complete, compositereduction of a bone fracture, comprising a patient support platform anda mechanical bone reduction fixture that can be mounted for use on thepatient support platform, and also illustrating the principal mechanicalaxes of the mechanical bone reduction fixture.

FIG. 18C is a top view of the system shown in FIGS. 18A and 18B in use,with an individual having a supracondylar fracture of a right arm layingin a prone position on the patient support platform, and the mechanicalbone reduction fixture supporting the humerus and forearm of theindividual in a manner conducive for reducing the supracondylar fractureof the right arm.

FIG. 18D is a top view of the system shown in FIGS. 18A and 18B in use,with an individual having a supracondylar fracture of a left arm layingin a prone position on the patient support platform, and the mechanicalbone reduction fixture supporting the humerus and forearm of theindividual in a manner conducive for reducing the supracondylar fractureof the left arm.

FIGS. 19A to 19F are views of the mechanical bone reduction fixtureshown in FIGS. 18A and 18B, showing in greater detail the mechanicalcomponents for applying force vectors for reducing a supracondylarfracture comprising distal traction, superior traction, lateraltranslation, varus/valgus rotation, pronation/suprination rotation, andflexion/extension, and also identifying directional points of referenceand the principal mechanical axes of movement.

FIG. 19G is a perspective view of an individual having a supracondylarfracture of a right arm laying in a prone position on a patient supportplatform, with the humerus and forearm of the individual orientated in amanner conducive for reducing a typical supracondylar fracture of theright arm, Figures.

FIG. 19H is a perspective view showing the mounting of a mechanical bonereduction fixture as shown in FIGS. 19A to 19F to a side rail of apatient support platform as shown in FIG. 19G for use.

FIGS. 20A to 20C are, respectively, a Free Side perspective view andcompanion Right Side elevation views of the mechanical bone reductionfixture shown in FIGS. 19A to 19F, with the principal components thatfunction to achieve distal traction shaded for identification, and alsoidentifying the directional points of reference and the principalmechanical axis of movement for distal traction, consistent with FIG.19A.

FIGS. 21A to 21C are, respectively, a Free Side perspective view andcompanion Right Side elevation views of the mechanical bone reductionfixture shown in FIGS. 19A to 19F, with the principal components thatfunction to achieve superior traction shaded for identification, andalso identifying the directional points of reference and the principalmechanical axis of movement for superior traction, consistent with FIG.19A.

FIGS. 22A to 22D are, respectively, a Support Side perspective view, anenlarged partial perspective view, and companion Top views of themechanical bone reduction fixture shown in FIGS. 19A to 19F, with theprincipal components that function to achieve lateral translation shadedfor identification, and also identifying in FIGS. 22A, 22C, and 22D thedirectional points of reference and the principal mechanical axis ofmovement for lateral translation, consistent with FIG. 19A.

FIGS. 23A to 23D are, respectively, a Free Side perspective view, anenlarged partial Top view, and companion Free Side elevation views ofthe mechanical bone reduction fixture shown in FIGS. 19A to 19F, withthe principal components that function to achieve varus/valgus rotationshaded for identification, and also identifying in FIGS. 23A, 23C, and23D the directional points of reference and the principal mechanicalaxis of movement for varus/valgus rotation, consistent with FIG. 19A.

FIGS. 24A to 24E are, respectively, a Support Side perspective view, anenlarged partial Top view, an enlarged partial Free Side View, andcompanion Top views of the mechanical bone reduction fixture shown inFIGS. 19A to 19F, with the principal components that function to achievepronation/supination rotation shaded for identification, and alsoidentifying in FIGS. 24A, 24D, and 24E the directional points ofreference and the principal mechanical axis of movement forpronation/supination rotation, consistent with FIG. 19A.

FIGS. 25A to 25C are, respectively, a Support Side perspective view, anenlarged partial Top view and companion Right Side elevation views ofthe mechanical bone reduction fixture shown in FIGS. 19A to 19F, withthe principal components that function to achieve flexion/extensionrotation shaded for identification, and also identifying the directionalpoints of reference and the principal mechanical axis of movement forflexion/extension rotation, consistent with FIG. 19A.

FIGS. 26A and 26B are enlarged Right Side perspective views (with FIG.26B partially cut away and in section), showing the distal traction spurgear and companion horizontal rack that form a part of the mechanicalbone reduction fixture shown in FIGS. 19A to 19F, which function toapply distal traction.

FIGS. 27 and 28 are, respectively, Right Side and Left Side perspectiveelevation views of an exemplary pin guide assembly for mechanicallyfixing a supracondylar fracture following reduction.

FIGS. 29 and 30A are, respectively, a Right Side elevation view and aTop view of the pin guide assembly shown in FIGS. 27 and 28 mounted foruse an alignment rail in association with a mechanical bone reductionfixture as shown in FIGS. 19A to 19F, for mechanically orienting andguiding a bone fixing device for fixing a supracondylar fracturefollowing reduction.

FIG. 30B is an illustration of a radiographic image showing a bonefixing device being advanced under the guidance by an a-p guide pin,which has been oriented by manipulation the pin guide assembly shown inFIGS. 29 and 30A.

FIG. 31A is a Top view of the pin guide assembly shown in FIGS. 27 and28 mounted for use an alignment rail in association with a mechanicalbone reduction fixture as shown in FIGS. 19A to 19F, showing themechanical orientation and guidance of a bone fixing device by the pinguide assembly for fixing a supracondylar fracture following reduction.

FIG. 31B is an anatomic side section view of a reduced supracondylarfracture following insertion of two bone fixing devices under guidanceby the pin guide assembly shown in FIGS. 27 and 28 to fix the reduction.

FIG. 32 is a perspective view of the pin guide assembly shown in FIGS.27 and 28 mounted for use an alignment rail, also identifying thetranslation of the bone fixing device guide by the pin guide assembly indifferent horizontal, vertical, and rotational paths.

FIGS. 33A and 33B are perspective end views of a guide bushing that canbe mounted at the instance of use in a sterile condition on the bonefixing device guide of the pin guide assembly shown in FIGS. 27 and 28.

FIG. 34 is a top view of the guide bushing shown in FIGS. 33A and 33Bpackaged in a sterile condition within a pouch prior to use inassociation with the pin guide assembly.

FIG. 35 is an exploded perspective view of the mounting of the guidebushing shown in FIGS. 33A and 33B on the bone fixing device guide ofthe pin guide assembly shown in FIGS. 27 and 28 at the instance of use.

FIG. 36 is a perspective view of an exemplary orthotic brace that can beassembled to stabilize a fixed bone reduction for healing.

FIG. 37 is a side elevation view demonstrating the temporary fitment ofthe orthotic brace shown in FIG. 36 in association with a mechanicalbone reduction fixture, like that shown in FIGS. 19A to 19F.

FIG. 38 is a perspective view of the orthotic brace shown in FIG. 36being worn by an individual after the bone fracture has beenmechanically reduced and fixed.

FIG. 39 is a perspective view of another exemplary orthotic brace thatcan be assembled to stabilize a fixed bone reduction for healing, theorthotic brace comprising a proximal brace component for assembly on ahumeral region of s supracondylar fracture, a distal brace component forassembly on a radius/ulnar region of a supracondylar fracture, and anadditional third brace component for assembly on wrist region distal tothe radius/ulnar region of the supracondylar fracture.

FIGS. 40 and 41 are side elevation views of the orthotic brace shown inFIG. 39, demonstrating the ability to adjust the spacing between thedistal brace component and the third brace component.

FIGS. 42A and 42B are side elevation views of the orthotic brace shownin FIG. 39, showing the articulation of the proximal and distal bracecomponents within a range of rotational orientations to accommodateforces applied to reduce the fracture.

FIG. 42C is an enlarged view (in section) of the articulating linkageand associated locking mechanism of the orthotic brace shown in FIGS.42A and 42B, which accommodate the rotational orientations shown inFIGS. 42A and 42B and the ability to maintain a desired rotationalorientation within the range to maintain a desired reduction of thefracture.

FIG. 43 is a side elevation view of the orthotic brace shown in FIG. 39,demonstrating the ability to axially adjust the spacing between theproximal and distal brace components.

FIG. 44A is a side elevation view demonstrating the temporary fitment ofthe orthotic brace shown in FIGS. 42A and 42B in association with amechanical bone reduction fixture, like that shown in FIGS. 19A to 19F.

FIGS. 44B and 44C are enlarged perspective views of the brace supportmechanisms that make possible the temporary fitment of the orthoticbrace shown in FIGS. 42A and 42B in association with a mechanical bonereduction fixture, like that shown in FIGS. 19A to 19F.

FIG. 45 is a perspective view of the orthotic brace shown in FIGS. 42Aand 42B being worn by an individual after the bone fracture has beenmechanically reduced and fixed.

FIG. 46A is a side elevation view of the system shown in FIGS. 18A and18B, with an individual having a supracondylar fracture of a right armlaying in a prone position on the patient support platform, and themechanical bone reduction fixture supporting the humerus and forearm ofthe individual in a manner conducive for reducing the supracondylarfracture of the right arm, in association a c-arm oriented to provide alateral radiographic image of the fracture.

FIG. 46B is an illustration of a lateral radiographic image of thesupracondylar fracture taken by the c-arm oriented in the manner shownin FIG. 46A.

FIG. 47A is a side elevation view of the system shown in FIGS. 18A and18B, with an individual having a supracondylar fracture of a right armlaying in a prone position on the patient support platform, and themechanical bone reduction fixture supporting the humerus and forearm ofthe individual in a manner conducive for reducing the supracondylarfracture of the right arm, in association a c-arm oriented to provide ana-p radiographic image of the fracture.

FIG. 47B is an illustration of an a-p radiographic image of thesupracondylar fracture taken by the c-arm oriented in the manner shownin FIG. 47A.

FIG. 48 is a top view of the system shown in FIGS. 18A and 18B in use,with an individual having a supracondylar fracture of a right arm layingin a prone position on the patient support platform, and the mechanicalbone reduction fixture (shown in FIGS. 19A to 19F) supporting thehumerus and forearm of the individual in a manner conducive for reducingthe supracondylar fracture of the right arm.

FIG. 49 is a top view of the system shown in FIGS. 18A and 18B in use,with an individual having a supracondylar fracture of a right arm layingin a prone position on the patient support platform, and the mechanicalbone reduction fixture (shown in FIGS. 19A to 19F) supporting thehumerus and forearm of the individual in a manner conducive for reducingthe supracondylar fracture of the right arm, with the orthotic braceshown in FIGS. 42A and 42B also fitted in association with a mechanicalbone reduction fixture during use, as shown in FIG. 44A.

FIGS. 50 and 51 are respectively, perspective views of an a-p cross hairdevice and a lateral cross hair device that are used, with radiographicimaging, to align the mechanical bone reduction fixture (shown in FIGS.19A to 19F) relative to the supracondylar fracture prior to reduction ofthe fracture.

FIG. 52 shows the placement of the a-p cross hair device shown in FIG.50 in a position to align the mechanical bone reduction fixture in ana-p plane relative to the supracondylar fracture prior to reduction ofthe fracture.

FIG. 53 is an illustration of an a-p radiographic image showing thealignment of the mechanical bone reduction fixture in an a-p planerelative to the supracondylar fracture prior to reduction of thefracture.

FIG. 54 shows the placement of the lateral cross hair device shown inFIG. 51 in a position to align the mechanical bone reduction fixture ina lateral plane relative to the supracondylar fracture prior toreduction of the fracture.

FIG. 55 is an illustration of a lateral radiographic image showing thealignment of the mechanical bone reduction fixture in a lateral planerelative to the supracondylar fracture prior to reduction of thefracture.

FIG. 56 is a Free Side perspective view of the mechanical bone reductionfixture shown in FIGS. 19A to 19F with the a-p cross hair device and alateral cross hair device (shown, respectively, in FIGS. 50 and 51) intheir correct positions to align, with the aid of radiographic imaging,the mechanical bone reduction fixture in a-p and lateral planes relativeto the supracondylar fracture prior to reduction of the fracture.

FIGS. 57 to 80 are views exemplifying a method for achieving mechanicalforce reduction of a bone fracture by the application of mechanicalforce reduction vectors comprising distal traction, superior traction,lateral translation, varus/valgus rotation, pronation/supinationrotation, and flexion/extension, by use of a system like that shown inFIGS. 18A and 18B.

FIG. 81 is a perspective view of a system that includes robotic/computercontrol for achieving mechanical force reduction of a bone fracture bythe application of force reduction vectors.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Although the disclosure hereof is detailed and exact to enable thoseskilled in the art to practice the invention, the physical embodimentsherein disclosed merely exemplify the invention which may be embodied inother specific structures. While the preferred embodiment has beendescribed, the details may be changed without departing from theinvention, which is defined by the claims.

This Specification discloses various devices, systems, and methods forreducing and/or fixing bone fractures, simple or complex, in children oradults, and involving all bone types, including, e.g., in the arm,involving the humerus and/or forearm and/or wrist; in the leg, involvingthe tibia and/or fibula; and at, in, or near articulating condyles (alsocalled a condylar fracture), e.g. at, in, or near the elbow, or at, in,or near the knee. The technical features of the devices systems andmethods can be well exemplified and highlighted with respect to thereduction and fixation of supracondylar fractures of the elbow. For thisreason, the devices, systems, and methods will be described in thiscontext.

Still, it is to be appreciated that the devices, systems, and methodsthat embody features of the invention are not restricted tosupracondylar applications. It is to be appreciated that the discloseddevices, systems, and methods are readily applicable for use in treatingall types of bone fractures, simple or complex, of any bone type, inchildren or adults, anywhere in the body.

I. Anatomy of the Elbow

FIGS. 4, 5, and 6 exemplify the complex nature of the human elbow andits various interacting components.

As can be seen in FIGS. 4, 5, and 6, the human elbow is formed by thearticulation of three bones; namely, the lower end of the humerus, theupper end of the radius, and the upper end of the ulna. Involvement ofthese three bones means that the human elbow consists of three joints;namely, those located (i) between the humerus and the ulna (theulno-humeral joint); (ii) between the humerus and the radius (theradio-humeral joint); and (iii) between the ulna and the radius (theradio-ulnar joint).

Part of the ulna that articulates with the humerus includes theolecranon process and the coronoid process. The corresponding part ofhumerus that articulates with these processes is called the trochlea.The head of the radius articulates with the capitulum of the humerus.

II. Supracondylar Fractures

The supracondylar region (see FIGS. 4, 5, and 6) in general encompassesan area of relatively thin, weak bone located in the distal humerus.This region is bordered posteriorly by the olecranon fossa andanteriorly by the coronoid fossa.

One type of fracture to the elbow is a supracondylar fracture (see FIGS.7 and 8). Supracondylar fractures are relatively common in children, andmay occur for example, when a child falls onto an outstretched arm. Withattention to the illustrated detailed views, it may be seen that theforce of a fall is transmitted through the olecranon to the weaksupracondylar region, causing a supracondylar fracture.

The fracture line typically propagates transversely across the distalhumerus through the center of the olecranon fossa. As FIGS. 7 and 8show, the supracondylar fracture separates the supracondylar region intoa proximal fracture region and a distal fracture region. The proximalfracture region includes at least a portion of the humerus (in thiscontext, “proximal” meaning on the side of the fracture line closer tothe shoulder). The distal fracture region includes at least a portion ofthe radius and/or the ulna (together comprising the forearm) (in thiscontext, “distal” meaning the side of the fracture line closer to thehand).

Depending on the severity of the fracture, the separated proximal anddistal bone regions can be displaced laterally right and left (i.e.,anatomically, in a medial direction toward the body or laterally awayfrom the body). For example, FIGS. 7 and 8 show, respectively, anteriorand posterior views of a supracondylar fracture of the right elbow, withthe distal fracture region displaced laterally to the left (toward thebody) and the proximal fracture region displaced medially to the right(away from the body).

Also depending on the severity of the fracture, the separated proximaland distal bone regions can be displaced forward or backwards (i.e.,anatomically, to the anterior (front) or to the posterior (back),respectively). For example, FIG. 9 shows a medial view (looking towardthe body) of a supracondylar fracture of the right elbow, with thedistal fracture region displaced in a posterior direction (toward theback) and the proximal fracture region displaced in an anteriordirection (toward the front).

In addition to the forgoing separations and displacements of the distalfracture segment relative to the proximal fracture segment, the angularalignment of the anterior, posterior, and medial cortical surfaces ofthe bones in the supracondylar region may be displaced rotationallyabout the native longitudinal axis of the bones. For example, FIG. 10shows a medial view (looking toward the body) of a supracondylarfracture of the right elbow, with the distal fracture region andproximal fracture region displaced rotationally out of their nativeaxial alignment.

III. Reducing and Fixing a Bone Fracture

In conventional meaning, a fracture is “reduced” by the application ofone or more forces to return the bone regions separated and displaced bythe fracture back toward the native state of alignment, i.e., that whichexisted prior to the fracture. In conventional meaning, a fracture is“fixed” following a reduction, by stabilizing the alignment of thereduction, to prevent the reduced bone regions from moving out ofreduction as healing occurs.

Depending upon the native anatomic structure of a given fracture site,and the nature of the fracture itself, reduction and fixation of a givenfracture can be difficult, inexact, and time consuming. This isparticularly true for fractures in the supracondylar region, aspreviously described, due to the nature and extent to which the nativebone structures can be separated and displaced by the fracture.

The morphology and interrelationship of native anatomic structures in agiven region of the body can be generally understood by medicalprofessionals using textbooks of human skeletal anatomy along with theirknowledge of the site. The physician is also able to ascertain thenature and extent of the fracture in that region of the body using, forexample, plain film x-ray, fluoroscopic x-ray, or MRI or CT scanning.Based upon this information, the physician can ascertain the magnitudeand direction of forces that ideally should be applied to achieve acomplete reduction of the fracture. In this specification, the magnitudeand direction of these forces will be called “force reduction vectors.”A force reduction vector represents a reduction force operating in adefined direction and magnitude.

These general principles can be applied for the purpose of illustrationto the humerus and elbow to treat the supracondylar region, whichcomprises the humerus, the forearm (comprising the ulna and radius),joined by the elbow joint. For example, as shown in FIGS. 11A and 11B,the humerus and forearm of an individual are shown orientated in amanner conducive for reducing a typical supracondylar fracture of theright arm. In this orientation, the humerus is extended at a right anglefrom the body axis, and the forearm is articulated upward relative tothe elbow. This orientation conducive for reduction of the fracture canalso be defined in terms of a fracture reduction coordinate system,which includes the principal anatomical reduction axes for a fracturedsupracondylar region.

The fracture reduction coordinate system comprises an anatomicalreduction perpendicular axis (sometimes in shorthand called the “ARPA”)(see FIG. 11A), which extends generally perpendicular to the body axisalong the native longitudinal axis of the humerus to the elbow. Thefracture reduction coordinate system also comprises an anatomicalreduction vertical axis (sometimes in shorthand called the “ARVA”) (seeFIG. 11B), which extends from the elbow upward along the nativelongitudinal axis of the forearm, generally perpendicular to the ARPA.The fracture reduction coordinate system further includes an anatomicalreduction horizontal axis (sometimes in shorthand call the “ARHA”) (seeFIGS. 11A and 11B), which extends through the native articulation axisof the elbow joint parallel to the body axis, which is generallyperpendicular to the ARPA and ARVA.

In summary, in the fracture reduction coordinate system, the ARPAextends along the native longitudinal axis of the humerus when orientedfor reduction of a supracondylar fracture. The ARVA defines the nativelongitudinal axis of the articulated forearm when orientated forreduction of a supracondylar fracture, the ARPA and ARVA beingperpendicular to each other. The ARHA defines the native articulationaxis of the elbow joint. FIG. 12A shows this orientation of the ARPA,ARVA, and ARHA, along with the presence of a supracondylar fracture,like that shown in FIGS. 7 to 10, thereby also defining the existence ofthe proximal bone region and the distal bone region as previouslydescribed.

With reference to the fracture reduction coordinate system shown inFIGS. 11A and 11B, the force reduction vectors required to achieve acomplete reduction of the supracondylar fracture can be identified. Aswill now be described in greater detail, there are a total of sixpossible force reduction vectors for a supracondylar fracture. These are(i) distal traction (FIGS. 12A to 12D); (ii) superior traction (FIGS.13A to 13D); (iii) lateral translation (FIGS. 14A to 14D); (iv)varus/valgus rotation (FIGS. 15A to 15D); (v) pronation/supinationrotation (FIGS. 16A to 16D); and (vi) flexion/extension rotation (FIGS.17A to 17D).

A. DISTAL TRACTION

FIG. 12A illustrates a first force reduction vector called distaltraction. Distal traction comprises a force vector applied along theARPA. As shown in FIGS. 12B, 12C, and 12D, distal traction along theARPA separates the distal bone region and the proximal fracture regionso that subsequent force reduction vectors can be applied to return theproximal and distal bone regions separated and displaced by the fractureback toward the native state of alignment.

B. Superior Traction

FIG. 13A illustrates a second force reduction vector called superiortraction. Superior traction comprises a force vector applied along theARVA. As shown in FIGS. 13B, 13C, and 13D, superior traction along theARVA lifts (or, in reserve, lowers) the distal bone region as a unitrelative to the proximal bone region. Superior traction returns proximaland distal bone regions that have been displaced due to the fractureforward or backwards (as shown in FIG. 9) back toward the native stateof alignment.

C. Lateral Translation

FIG. 14A illustrates a third force reduction vector called lateraltranslation. Lateral translation comprises a force vector applied alongthe ARHA. As shown in FIGS. 14B, 14C, and 14D, lateral translation alongthe ARHA moves the fractured end of the distal bone regions across thefractured end of the proximal bone region. Lateral translation returnsproximal and distal bone regions that have been medially displaced leftor right due to the fracture (as shown in FIGS. 7 and 8) back toward thenative state of alignment.

D. Varus/Valgus Rotation

FIG. 15A illustrates a fourth force reduction vector called varus/valgusrotation. Varus/valgus rotation comprises a rotational force vector(torque) applied about the ARPA. As shown in FIGS. 15B, 15C, and 15D,varus/valgus rotation about the ARPA pivots the fractured end of thedistal bone region about the longitudinal axis of the proximal boneregion. Varus/valgus rotation returns proximal and distal bone regionsthat have been rotationally displaced due to the fracture (as shown inFIG. 10) back toward the native state of alignment. Varus/valgusrotation serves to bring back into native alignment the posterior,anterior, and medial cortical surfaces along the fracture line.

E. Pronation/Supination Rotation

FIG. 16A illustrates a fifth force reduction vector calledpronation/supination rotation. Pronation/supination rotation comprises arotational force vector (torque) applied about the ARVA. As shown inFIGS. 16B, 16C, and 16D, pronation/supination rotation about the ARVApivots the fractured end of the distal bone region about thelongitudinal axis of distal bone. Like varus/valgus rotation,pronation/supination rotation returns proximal and distal bone regionsthat have been rotationally displaced due to the fracture (as shown inFIG. 10) back toward the native state of alignment. Pronation/supinationrotation also serves to bring back into native alignment the posterior,anterior, and medial cortical surfaces along the fracture line.

F. Flexion/Extension Rotation

FIG. 17A illustrates a sixth force reduction vector calledflexion/extension rotation. Flexion/extension rotation comprises arotational force vector (torque) applied about the ARHA. As shown inFIGS. 17B, 17C, and 17D, flexion/extension rotation about the ARHApivots the fractured end of the distal bone region toward the fracturedend of the proximal bone region. Flexion/extension rotation returns thefractured ends of the proximal and distal bone regions that have beenseparated due to the fracture back toward the native state of alignment.

IV. Systems and Devices for Mechanically Reducing a Bone Fracture

A. Overview

The rationale of systematically identifying force reduction vectors,although previously described in the context of reducing supracondylarfractures, provides the context for achieving, in a systematic way, areduction of any bone fracture. Still, in this context, systemicproblems can still exist.

Force reduction vectors, once identified, are inherently different interms of their therapeutic objectives and results. For example, in thecontext of reduction of a supracondylar fracture, the force reductionvectors independently operate along or about three different axes;namely the ARPA, ARVA, and ARHA. Achieving a desired therapeutic resultalong or about one axis can be lost or compromised when an attempt ismade to achieve a therapeutic result along or about another axis. Forexample, the therapeutic objectives of distal traction can be lost orcompromised when a different force reduction vector is next appliedalong another axis. The loss of distal traction can, in turn, obstructthe application of another force vector. Further, the application ofsuperior traction can alter the therapeutic results of a previouslyachieved lateral traction, or vice versa, or the application ofvarus/valgus rotation can alter the results of a previously achievedpronation/supination rotation or flexion/extension rotation, and so on.Force reduction vectors for whatever facture operate in a dynamicinterdependent physical environment. This dynamic interdependentphysical environment thwarts achievement of a complete reduction by theapplication of independent force reduction vectors along or aboutdifferent axes.

B. Mechanical Force Reduction

FIGS. 18A and 18B show, respectively, top and side views of an exemplarysystem 10 sized and configured for achieving a complete, compositereduction of a bone fracture. The system 10 overcomes the problemspresented by the dynamic interdependent physical environment of reducinga fracture—which has before now thwarted achievement of a completecomposite reduction—by independently applying and maintaining aplurality of disparate mechanical force reduction vectors concurrentlyalong disparate axes. The technical features and benefits of the system10 will be described in the context of reducing a supracondylarfracture, but the technical features that will be described areapplicable to reducing bone fractures, simple or complex, of all bonetypes, in children or adults.

The system 10 achieves a mechanical force reduction of the fracture. Theterm “mechanical force reduction” means a reduction of a bone fractureby the application of mechanical force, which will also sometimes becalled a “mechanical force vector” or a “force reduction vector.”

As used herein, the terms “mechanical” and “mechanism” broadly connotethe presence of one or more tools or instruments that generate andtransform the direction or magnitude of a force to reduce a bonefracture by applying kinetic energy and/or electrical energy and/orpneumatic energy and/or hydraulic energy and/or chemical energy, and/orthermal energy, and/or elastic energy, and combinations thereof. In thisrespect, the terms “mechanical” and “mechanism” as used herein apply notonly to the use of “machines” in the traditional sense (e.g., withcomponents such as axles, bearings, gears, linkages, springs, wheels,pulleys, motors, engines, compressors, pumps, pistons, and the like,interacting alone or in combination to generate and apply kineticforce), but also to any tool or instrument that generates/applies forceto reduce a bone fracture that includes, e.g., electrical and/orelectro-mechanical components, and/or pneumatic components, and/orhydraulic components, and/or electronic components, and/or mechatroniccomponents, and/or nanotechnology components, and can also incorporate,e.g., robotics, automation, and/or computer control.

Mechanical force reduction achieves, for the first time, a complete,composite reduction of a bone fracture by independently applying andmaintaining force reduction vectors in a mechanical way concurrentlyalong different axes.

As an overview, in a representative implementation, the system 10applies at least two external, mechanically generated forces to a bonefracture. One of the external mechanically generated forces comprises afirst mechanical force vector that moves a bone fracture into alignmentin a first anatomic orientation. The system 10 further mechanicallymaintains a desired alignment in the first anatomic orientation. Thesystem 10 applies another external, mechanically generated force,independent of the first mechanical force vector, comprising a secondmechanical force vector. The second mechanical force vector moves thebone fracture into alignment in a second anatomic orientation differentthan the first anatomic orientation. Because the system 10 mechanicallymaintains a desired alignment in the first anatomic orientation whileapplying the second mechanical force vector, alignment in a secondanatomic orientation is achieved without altering the desired alignmentin the first desired orientation.

In this way, the system 10 mechanically applies a given mechanical forcevector to achieve alignment in a first anatomic orientation, and whilemechanically maintaining the alignment achieved in the first anatomicorientation, proceeds to apply another mechanical force vector toachieve alignment in another anatomic orientation, and then mechanicallymaintains that alignment, and so on, until all desired alignments in allidentified anatomic orientations are made, to form a compositereduction. At that time, the system 10 can provide systematic mechanicalbone fixing of the composite reduction, as will be described in greaterdetail later.

In the context of treating a supracondylar fracture, and as will bedescribed in greater detail, the system 10 is capable of applyingmechanical force reduction in all six possible anatomic reductionorientations. As previously described, the six mechanical forcereductions for a supracondylar fracture comprise reduction by (i) distaltraction (previously exemplified in FIGS. 12A to 12D); (ii) superiortraction (previously exemplified in FIGS. 13A to 13D); (iii) lateraltranslation (previously exemplified in FIGS. 14A to 14D); (iv)varus/valgus rotation (previously exemplified in FIGS. 15A to 15D); (v)pronation/supination rotation (previously exemplified in FIGS. 16A to16D); and (vi) flexion/extension rotation (previously exemplified inFIGS. 17A to 17D). In this way, the system 10 makes possible, for thefirst time, a mechanically-achieved complete composite reduction of asupracondylar fracture.

The system 10 can be variously constructed to achieve this objective.Exemplary structural embodiments will now be described.

C. An Exemplary System for Reduction of a Supracondylar Fracture

1. Overview

As shown in FIGS. 18A and 18B, the system 10 comprises a patient supportplatform 12 and a mechanical bone fracture reduction fixture 14 mountedon the patient support platform 12. As will be described in greaterdetail later, the patient platform 12 is sized and configured to supportan individual having a bone fracture. The mechanical bone fracturereduction fixture 14 includes at least one fracture reduction mechanism16 that is sized and configured to apply to the bone fracture at leastone mechanical force vector that moves the bone fracture into at leastone desired anatomic orientation. The fracture reduction mechanism 16includes a mechanism that is sized and configured to mechanicallymaintain the desired anatomic orientation,

In a representative embodiment, the mechanical bone fracture reductionfixture 14 is sized and configured to be conveyed separate from thepatient platform 12. In this arrangement, the mechanical bone fracturereduction fixture 14 includes a mount 20 to join the fixture 14 to thepatient platform 12 to support the bone fracture for reduction by themechanical bone fracture reduction fixture 14 and, after a reduction ofthe fracture is achieved, to separate the fixture 14 from the patientplatform 12.

As will also be described in greater detail later, the system 10 canfurther include a mechanical guidance mechanism 18 that is sized andconfigured to guide placement of one or more bone fixing devices to fixthe reduction of the fracture.

In a representative embodiment, the mechanical bone fracture reductionfixture 14 and the mechanical guidance mechanism 18 share a common frame22. In this arrangement, the mount 20 joins the common frame 22 to thepatient platform 12 for fracture reduction by the mechanical bonefracture reduction fixture 14 and fixing by the mechanical guidancemechanism 18 and, after fracture reduction and fixing are achieved, toseparate the common frame 22 from the patient platform 12.

More particularly, the patient platform 12 is sized and configured toplace an individual having a supracondylar fracture in a comfortable,stable position in proximity to the fracture reduction fixture 14. Thepatient platform 12 can be, e.g., a chair; or a generally use horizontalresting surface, bed, or table suited for supporting the body of anindividual in a supine or prone position conducive for reducing afracture; or a general use, but more specialized surgical table orgurney, like those found in an emergency room or an operating room; oran even-more customized fracture reduction table or fixture customizedfor the needs orthopedic surgery (capable, e.g., of controlling theposition, articulation, and manipulation of a patient's lower and/orupper extremities). The fracture reduction fixture 14 supplements andcustomizes the technical features of the patient platform 12 to thereduction of the particular fracture of interest. In all arrangements,the fracture reduction fixture 14 comprises a temporary appendage to thepatient platform 12, providing it with the functionality customized forreducing the particular bone fracture, in this case, a supracondylarfracture. It should be appreciated however, that, if desired, thepatient platform 12 and the fracture reduction fixture 14 can beprovided as integrated unit.

In the exemplary embodiment shown in FIGS. 18A and 18B the system 10contemplates a modular-type construction. The fracture reduction fixture14 comprises a frame 22 having a support mount 20, which is sized andconfigured for temporary mounting to a patient platform 12 selected tocarry the individual being treated. The support mount 20 allows for thefracture reduction fixture 14 to be attached as a preassembled unit atthe instance of use to the selected patient platform 12 prior to use(see FIGS. 18A and 18B), to thereby form the system 10 at the instanceof use. The support mount 20 also allows the fracture reduction fixture14 to be removed as a preassembled assembly from the patient platform 12after use for storage and subsequent reuse on a different selectedpatient platform 12. Further details of the exemplary mount 20 are shownin FIG. 19A.

The provision of a support mount 20 on the fracture reduction fixture 14makes the fracture reduction fixture portable for placement on a siderail 24 that is typically part of a conventional operating table orgurney (also see FIGS. 19G and 19H). Other forms of support mounts canbe sized and configured to accommodate the particular structure of otherpatient platforms, such as customized fracture reduction tables orfixtures customized for the needs orthopedic surgery.

Attached to the patient platform 12, the fracture reduction fixture 14in the exemplary embodiment is supported at waist level for use in acantilevered orientation from a side of the patient platform 12, whichis an orientation that is conducive for the reduction of a supracondylarfracture. Reduction of another type of fracture may call for a differentorientation for the respective fracture reduction fixture 14, i.e., onethat is not cantilevered from and/or not supported on a side of thepatient platform 12, but is instead oriented above or below the patientplatform 12, and/or supported at or from another region of the patientplatform 12, because that particular orientation is conducive to thereduction of that particular fracture.

FIGS. 18A and 18B have been annotated to establish baseline directionalpoints of reference for the exemplary embodiment of the fracturereduction fixture 14 and the system 10 from a structural standpoint,which will be referred to in subsequent more detailed descriptions anddrawings. FIGS. 18A and 18B establish, for the fracture reductionfixture 14 and system 10, the baseline direction points of referencecalled a Support Side, a Free Side, Left, Right, Top and Bottom, asbased upon the structural orientation of fracture reduction fixture 14as shown in FIGS. 18A and 18B. That is, the Support Side, Free Side,Left Side, Right Side, Top, and Bottom directional points of referenceare relative to the view of a surgeon or caregiver when facing thepatient platform 12 and holding the fracture reduction fixture 14 toplace the support mount 20 on a support rail of the patient supportplatform 12. From this point of view, the surgeon faces the side rail 24of the patient support platform 12, holding the fracture reductionfixture 14 on the side opposite to the Support Side (i.e., the FreeSide) to present the Support Side to the side rail 24 for placement onthe side rail 24. From this perspective (viewed by the surgeon from theFree Side), the fracture reduction fixture 14 has a Left Side (to thesurgeon's left), a Right Side (to the surgeon's right), a Top (towardthe surgeon's head) and a Bottom (toward the surgeon's feet).

The orientation of the Left and Right Sides of the fracture reductionfixture 14 relative to head and feet of the patient when in use willvary depending upon whether the supracondylar fracture is in thepatient's right arm (FIG. 18C) or in the patient's left arm (FIG. 18D).For a right arm fracture, the Left Side of the fracture reductionfixture 14 faces the patient's head (FIG. 18C). For a left arm fracture,the Right Side of the fracture reduction fixture 14 faces the patient'shead (FIG. 18D).

The mechanical axes of the fracture reduction fixture 14 relative tothese directional points of reference are also identified in FIGS. 18Ato 18D. The mechanical axes comprise a Mechanical Horizontal Axis, whichextends between the Right and Left Sides; a Mechanical Vertical Axis,which extends between the Top and Bottom; and a Mechanical PerpendicularAxis, which extends between the Support Side and the Free Side.

These directional points of reference established for FIGS. 18A to 18Dare also carried into the companion FIGS. 19A to 19H, which show thedetails of an exemplary fracture reduction fixture 14 prior to placementon the patient platform 12. The mechanical axes established in FIGS. 18Ato 18D are further identified in FIG. 19A.

FIG. 19A is a perspective view of an exemplary fracture reductionfixture 14 (prior to placement on the patient platform 12) from theSupport Side. FIG. 19B is a perspective view of the fracture reductionfixture 14 from the Right Ride. FIG. 19C shows the fracture reductionfixture 14 in a top plane view from the Top of FIGS. 19A and 19B; FIG.19D shows the fracture reduction fixture 14 in an elevation view fromthe Free Side. FIG. 19E is an elevation view of the fracture reductionfixture 14 from the Right Side, and FIG. 19F is an elevation view of thefracture reduction fixture 14 from the Left Side.

In the embodiment shown in FIGS. 19G and 19H, the support mount 20comprises a flange or bracket projecting from the Support Side, which issized and configured to be hung on a conventional side rail 24 or edgeof an operating table or gurney (which then comprises the patientsupport platform 12). For example, FIG. 19H shows the flange or bracket20 being situated on the side rail 24, with the side rail 24 providinggeneral support for the fracture reduction fixture 14 cantilevered fromthe patient platform 12 at generally the waist level of the surgeon orcaregiver (see FIG. 18B). The support mount 20 also desirably includesone or more suitable securing elements 130 (see FIG. 19B), e.g. afriction screw device, for providing a rigid point of attachment of thefracture reduction fixture 14 to the patient platform 12, therebyforming the system 10 ready for use.

The support mount 20 can be fabricated from durable machined or moldedmetal parts, which can be shaped in conventional fashion, e.g., bymolding, fasteners, and/or welding. Likewise the design of the securingelement can be of any arrangement that will allow the fracture reductionfixture 14 to be securely and rigidly attached to a patient platform 12,or other selected surface that a patient will lie upon, as demonstratedin FIG. 19G.

The design and positioning of the support mount 20 allows for horizontalstabilization of the patient on the patient platform 12, in anorientation that is conducive for reduction and (desirably) fixing ofthe patient's fracture. Particularly, the orientation of the fracturereduction fixture 14 relative to the patient platform 12 orients thepatient's humerus and radius/ulna in the fracture reduction fixture 14for reduction and (desirably) fixing of the fracture.

2. Orienting the Fracture for Reduction

In the illustrated embodiment (see, e.g., FIGS. 18C, 18D, and 19G), thepatient platform 12 is sized and configured to comfortably support theupper torso of the individual to be treated, at rest in a supine (on theback) position. The patient platform 12 can be sized and configured tosupport an adult's upper torso and/or a child's upper torso. In theillustrated embodiment, the patient platform 12 is intended to supportat least the torso of a child. Stabilization for the individual's torsocan be provided, as desired, by straps across the supine torso fitted tothe patient platform 12.

In the illustrated embodiment (see FIGS. 18C and 18D), the fracturereduction fixture 14 is sized and configured to comfortably support theappendage of the individual having the fracture that is to be reducedwhile lying on the patient platform 12. In the illustrated embodiment,the appendage is an arm having a supracondylar fracture. The fracturereduction fixture 14 orients the fracture along the desired fracturereduction coordinate system, which, for a supracondylar fracture, isshown in FIGS. 11A and 11B.

The fracture reduction fixture 14 is sized and configured to support anadult's arm or a child's arm, depending upon who the individual to betreated is. In the illustrated embodiment, the fracture reductionfixture 14 is sized and configured for treatment of a child. This isalso shown later, e.g., in FIG. 48.

In this arrangement (see FIG. 19A), the fracture reduction fixture 14includes a humeral support carriage 26, which extends parallel to theMechanical Perpendicular Axis between the Support Side and the FreesSide of the fracture reduction fixture 14. In use, the humeral supportcarriage 26 is secured to the humerus, to hold the humerus in alaterally extended position from the shoulder, as FIGS. 18C and 18Dshow.

The fracture reduction fixture 14 also includes (see FIG. 19A) aradius/ulna support carriage 28, which extends parallel to theMechanical Vertical Axis between the Top and the Bottom of the fracturereduction fixture 14. In use, the radius/ulna support carriage 28 issecured to the radius/ulna, to hold the radius/ulna while flexed at theelbow to point the hand in a superior direction facing the shoulder, asFIGS. 18C and 18D show.

3. Mechanical Force Reduction Assemblies

The fracture reduction mechanism 16 carried by the fracture reductionfixture 14 comprises a plurality of mechanical force reductionassemblies 30, 32, 34, 36, 38, 40. The mechanical force reductionassemblies 30, 32, 34, 36, 38, and 40 are carried by the frame 22 of thefracture reduction fixture 14 in a prescribed mechanical associationwith the humeral support carriage 26 and the radius/ulna supportcarriage 28.

Each of the mechanical force reduction assemblies 30, 32, 34, 36, 38,and 40 is sized and configured to independently mechanically manipulatethe arm resting in the humeral support carriage 26 and the radius/ulnasupport carriage 28, guided by conventional radiation imagingtechniques. Each mechanical force reduction assembly 30, 32, 34, 36, 38,and 40 functions independently of the other mechanical force reductionassemblies, to independently apply and maintain one of the prescribedmechanical reduction forces to the fracture. Concurrently, themechanical force reduction assemblies 30, 32, 34, 36, 38, and 40mechanically apply and maintain a plurality of independent mechanicalreduction forces, to thereby mechanically reduce the fracture in thedesired reduction planes.

Because the proximal and distal fracture regions held by the fracturereduction fixture 14 are mechanically manipulated with the aid ofconventional radiation imaging techniques, the mechanical forcereduction assemblies 30, 32, 34, 36, 38, and 40 and companion componentsof the fixture 14 are desirably made from metallic and/or non-metallicmaterials that do not block x-ray visualization. In this way, mechanicalreduction can be performed using the fixture 14 without interfering withthe radiologic visualization of the fracture site as reduction occurs.For example, Delrin® Plastic (DuPont) can be used, since it is possibleto image through it.

In the context of reducing a supracondylar fracture, there are sixmechanical force reduction assemblies 30, 32, 34, 36, 38, and 40. Thesix mechanical force reduction assemblies correspond to six mechanicalforce reductions identified for a supracondylar fracture. In thiscontext, the mechanical force reduction assemblies carried by thefracture reduction fixture 14 comprise (i) a distal traction mechanicalforce reduction assembly 30; (ii) a superior traction mechanical forcereduction assembly 32; (iii) a lateral translation mechanical forcereduction assembly 34; (iv) a varus/valgus rotation mechanical forcereduction assembly 36; (v) a pronation/supination rotation mechanicalforce reduction assembly 38; and (vi) a flexion/extension rotationmechanical force reduction assembly 40. Concurrently, the six mechanicalforce reduction assemblies 30, 32, 34, 36, 38, and 40 carried by thefracture reduction fixture 14 make possible a mechanically-achievedcomplete composite reduction of a supracondylar fracture.

Further details of each mechanical force reduction assembly 30, 32, 34,36, 38, and 40 will now be described, with reference to the exemplaryembodiment shown in FIGS. 19A to 19F.

i. Distal Traction Mechanical Force Reduction Assembly

The distal traction mechanical force reduction assembly 30 mechanicallyapplies and maintains distal traction to the fracture. As beforedescribed, and as earlier shown in FIGS. 12A to 12D, distal tractioncomprises a force vector applied along the Anatomical ReductionPerpendicular Axis of the fracture reduction coordinate system of thesupracondylar region. Distal traction along the Anatomical ReductionPerpendicular Axis separates the distal bone region and the proximalfracture region so that subsequent force reduction vectors can beapplied to return the proximal and distal bone regions separated anddisplaced by the fracture back toward the native state of alignment.

a. Mechanically Achieving Distal Traction

In the exemplary embodiment (initially, referring to FIG. 19A) thedistal traction mechanical force reduction assembly 30 comprises ahorizontal traction carriage 42. The horizontal traction carriage 42 isstructurally coupled to the radius/ulna support carriage 28 by a linkagesystem 44, the components of which will be more fully described ingreater detail later. The horizontal traction carriage 42 and thelinkage system 44 that mechanically couples it to the radius/ulnasupport carriage 28, shown in FIG. 19A, are further shaded foridentification in FIG. 20A, which (like its companion FIGS. 20B and 20C)also incorporates the directional points of reference and the principalmechanical axis of movement for distal traction established in FIG. 19A.

With reference to FIG. 20A, it can be seen that the horizontal tractioncarriage 42 is movable in a linear path in a distal traction horizontalplane along the Mechanical Perpendicular Axis (that is, between the FreeSide and the Support Side). In the exemplary embodiment, the horizontaltraction carriage 42 moves on a horizontal rail 46, which is supportedon a u-shape frame on the Right Side of the fracture reduction fixture14.

Referring to FIGS. 20A and 20C, the radius/ulna support carriage 28 isstructurally coupled by a linkage system 44 to the horizontal tractioncarriage 42, so that linear movement of the horizontal traction carriage42 along the horizontal rail 46 likewise linearly moves the radius/ulnasupport carriage 28 in a parallel path along the MechanicalPerpendicular Axis between the Support Side and the Free Side of thefracture reduction fixture 14. This linear movement can also beconsidered to be a “translation.” This linear movement of theradius/ulna support carriage 28 in tandem with movement of thehorizontal traction carriage 42 along the Mechanical Perpendicular Axisof the fracture reduction fixture 14 is also shown from a Right Sideperspective in FIG. 20C.

As shown in FIGS. 20A and 20C, the humeral support carriage 26 is notcoupled to the horizontal traction carriage 42. Thus, the humeralsupport carriage 26 remains stationary during linear movement of thehorizontal traction carriage 42 along the Mechanical Perpendicular Axis.As a result, linear movement of the horizontal traction carriage 42 alsomoves the radius/ulna support carriage 28 along the MechanicalPerpendicular Axis laterally closer to or farther from the humeralsupport carriage 26 (as FIGS. 20B and 20C show).

The distal traction mechanical force reduction assembly 30 moves thehorizontal traction carriage 42 in a horizontal plane along theMechanical Perpendicular Axis toward the Free Side of the fracturereduction fixture 14 to mechanically achieve distal traction of thesupracondylar fracture along the Anatomical Reduction Perpendicular Axisof the fracture reduction coordinate system of the supracondylar region(see FIG. 12A) (see FIGS. 20B and 20C). This is because moving thehorizontal traction carriage 42 toward the Free Side along thePerpendicular Mechanical Axis also moves the radius/ulna supportcarriage 28, which holds the distal bone region, in a linear path towardthe Free Side farther away from the then-stationary humeral supportcarriage 26, which holds the proximal bone region, thereby separatingthe distal bone region and the proximal bone region along the AnatomicalReduction Perpendicular Axis (as FIG. 12C shows).

b. Mechanically Adjusting and Maintaining Distal Traction

In the exemplary embodiment, the distal traction mechanical forcereduction assembly 30 includes a distal traction spur gear 48, whichrides along a horizontal rack 50. The distal traction spur gear 48 andhorizontal rack 50 can be seen in FIG. 20B, 20C, and in a perspectiveenlarged view in FIGS. 26A and 26B. In this implementation, the distaltraction spur gear 48 is advanced along the horizontal rack 50 byrotation of a distal traction control knob 52 on the Right Side of thefracture reduction fixture 14 in a clockwise or counterclockwisedirection (see FIGS. 20B and 26A), to reach a desired degree of distalreduction. Advancement of the distal traction spur gear 48 along thehorizontal rack 50 in response to rotation of the distal tractioncontrol knob 52 allows for micro-control of the distal tractionmechanical force assembly. The design of the distal traction spur gear48 and the horizontal rack 50 maintains the distal traction mechanicalforce assembly in a fixed position in the absence of rotation of thedistal traction control knob. As a further arrangement, the distaltraction control knob 52 may be designed to include a locking mechanismso that it can be extended outwardly or pushed inwardly to frictionallyresist rotation of the distal traction control knob.

As shown in FIGS. 26A and 26B, rotation of the distal traction controlknob 52 results in rotation of the distal traction spur gear 48 and itsadvancement along the horizontal rack 50. Rotation of the distaltraction spur gear 48 along the horizontal rack 50 advances thehorizontal traction carriage 42 along the mechanical horizontal axis inprecise linear increments in response to rotation of the distal tractionspur gear clockwise or counterclockwise, depending on the direction andspeed of rotation of the knob 52.

As will be exemplified in greater detail later, the distal tractionmechanical force reduction assembly 30 applies mechanical forcereduction to achieve distal traction, which can be maintained or lockedwhile other, different mechanical reduction forces are applied by thesystem 10.

ii. Superior Traction Mechanical Force Reduction Assembly

The superior traction mechanical force reduction assembly 32mechanically applies and maintains superior traction to the fracture. Asbefore described, and as earlier shown in FIGS. 13A to 13D, superiortraction comprises a force vector applied along the Anatomical ReductionVertical Axis of the fracture reduction coordinate system of thesupracondylar region. Superior traction along the Anatomical ReductionVertical Axis lifts (or, in reverse, lowers) the distal bone region as aunit relative to the proximal bone region, to return proximal and distalbone regions that have been displaced due to the fracture forward orbackwards back (as shown in FIG. 9) toward the native state ofalignment.

a. Mechanically Achieving Superior Traction

In the exemplary embodiment (initially, referring to FIG. 19A), thesuperior traction mechanical force reduction assembly 32 comprises avertical traction carriage 54 structurally coupled to the radius/ulnasupport carriage 28 by the same linkage system 44 that couples thehorizontal traction carriage 42 to the radius/ulna support carriage 28.The vertical traction carriage 54 and the linkage system 44 by which itis mechanically coupled to the radius/ulna support carriage 28, shown inFIG. 19A, are further shaded for identification in FIG. 21A, which (likeits companion FIGS. 21B and 21C) also incorporates the directionalpoints of reference and the principal mechanical axis for superiortraction established in FIG. 19A.

With reference to FIG. 21A, it can be seen that the vertical tractioncarriage 54 is movable in a linear path in a superior traction verticalplane along the Mechanical Vertical Axis (that is, toward the Top and/ortoward the Bottom of the fracture reduction fixture 14). The verticaltraction carriage 54 moves on a vertical rail 56, which is supported onthe linkage system 44 on the Right Side of the fracture reduction frame22 above the horizontal traction carriage 42.

Referring to FIGS. 21A and 21C, the radius/ulna support carriage 28 isstructurally coupled to the vertical traction carriage 54, so thatlinear movement of the vertical traction carriage 54 along the verticalrail 56 likewise moves the radius/ulna support carriage 28 in a parallelpath along the Mechanical Vertical Axis between the Top and Bottom ofthe fracture reduction fixture 14. The linear movement can also beconsidered to be a “translation.” This linear movement of theradius/ulna support carriage 28 in tandem with the vertical tractioncarriage 54 along the mechanical vertical axis of the fracture reductionfixture 14 is also shown from a Right Side perspective in FIG. 21C).

As shown in FIGS. 21A and 21C, the humeral support carriage 26 is notcoupled to the movable vertical traction carriage 54. The humeralsupport carriage 26 remains stationary during linear movement of thevertical traction carriage 54 along the Mechanical Vertical Axis. As aresult, linear movement of the vertical traction carriage 54 along theMechanical Vertical Axis likewise moves the radius/ulna support carriage28 along the Mechanical Vertical Axis in a superior traction verticalplane farther from or closer to the humeral support carriage 26 (asFIGS. 21B and 21C show).

The superior traction mechanical force reduction assembly 32 moves thevertical traction carriage 54 in a vertical plane along the MechanicalVertical Axis toward the Top of the fracture reduction fixture 14 tomechanically achieve superior traction along the Anatomical ReductionVertical Axis of the fracture reduction coordinate system of thesurpracondylar region (see FIG. 13A). This is because moving thevertical traction carriage 54 along the Mechanical Vertical Axis towardthe Top also moves the radius/ulna support carriage 28 (holding thedistal bone region) toward the Top (i.e., superior direction) away fromthen-stationary humeral support carriage 26 (holding the proximalfracture region), thereby separating the distal bone region and theproximal fracture region along the Anatomical Reduction Vertical Axis(as FIG. 13C shows).

b. Mechanically Adjusting and Maintaining Superior Traction

In the exemplary embodiment, the superior traction mechanical forcereduction assembly 32 includes a superior traction spur gear 58, whichrides along a vertical rack 60, as shown in FIGS. 22B and 22C. Thesuperior traction spur gear 58 and vertical rack 60 of the superiortraction mechanical force reduction assembly 32 has the same generallymechanical construction and operation as the distal traction spur gear48 and companion horizontal rack 50 described in connection with thedistal traction mechanical force reduction assembly 30 (shown in FIGS.26A and 26B).

In this implementation, the superior traction spur gear 58 is advancedalong the vertical rack 60 by rotation of a superior traction controlknob 62 on the Right Side of the fracture reduction fixture 14 inclockwise or counterclockwise direction, to reach a desired degree ofsuperior traction reduction. The superior traction spur gear 58 and thevertical rack 60 allows for micro-control of the distal tractionmechanical force reduction assembly 30. The design of the superiortraction spur gear 58 and the vertical rack 60 maintains the distaltraction mechanical force reduction assembly 30 in a fixed position inthe absence of rotation of the superior traction control knob 62. As afurther arrangement, the superior traction control knob 62 may bedesigned to include a locking mechanism so that it can be extendedoutwardly or pushed inwardly to frictionally resist rotation of thesuperior traction control knob 62.

The rotation of the superior traction control knob 62 results inrotation of the superior traction spur gear and its advancement alongthe vertical rack 60. Rotation of the superior traction spur gear 58along the rack advances the vertical traction carriage 54 in preciselinear increments along the Mechanical Vertical Axis in response torotation of the superior traction spur gear 58 clockwise orcounterclockwise, depending on the direction and speed of rotation ofthe superior traction control knob 62.

As will be exemplified in greater detail later, the superior tractionmechanical force reduction assembly 32 applies mechanical forcereduction to achieve superior traction, which can be maintained orlocked while other, different mechanical reduction forces are applied bythe system.

iii. Lateral Translation Mechanical Force Reduction Assembly

The lateral translation mechanical force reduction assembly 34mechanically applies and maintains lateral translation or traction tothe fracture. As before described, and as earlier shown in FIGS. 14A to14D, lateral translation comprises a force vector applied along theAnatomical Reduction Horizontal Axis of the fracture reductioncoordinate system of the supracondylar region. Lateral translation alongthe Anatomical Reduction Horizontal Axis moves the fractured end of thedistal bone regions across the fractured end of the proximal boneregion. Lateral translation returns proximal and distal bone regionsthat have been medially displaced left or right due to the fracture (asshown in FIGS. 7 and 8) back toward the native state of alignment.

a. Mechanically Achieving Lateral Translation

In the exemplary embodiment (initially, refer to FIGS. 19A and 19B), thelateral translation mechanical force reduction assembly 34 comprises alateral translation carriage 64. The lateral translation carriage 64supports the humeral support carriage 26. The lateral translationcarriage 64 is best shown in FIGS. 19A and 19B, and is further shadedfor identification in FIG. 22A, which (like its companion FIGS. 22C and22D) also incorporates the directional points of reference and theprincipal mechanical axis for lateral translation established in FIG.19A.

With reference to FIG. 22A, it can be seen that the lateral translationcarriage 64 comprises a support bed 66 that is carried for movementalong the Mechanical Horizontal Axis by a cross bar 68 and a parallelcompanion threaded cross bolt 70 (see also FIG. 22B), which are mutuallycoupled between a pair of Left and Right supports cantilevered on theSupport Side toward the Free Side of the support mount 20. The humeralsupport carriage 26 is supported on the support bed 66 (as FIG. 22Ashows). The support bed 66 and humeral support carriage 26 are movablealong the cross bar 68 and parallel threaded cross bolt 70 in a linearpath in a lateral translation horizontal plane along the MechanicalHorizontal Axis (that is, between the Left Side and the Right Side) ofthe fracture reduction fixture 14.

Referring to FIGS. 22A and 22D, the radius/ulna support carriage 28 isnot coupled to the lateral translation carriage 64. The radius/ulnasupport carriage remains stationary during linear movement of thelateral translation carriage 64 along the Mechanical Horizontal Axis. Asa result, linear movement of the lateral translation carriage 64likewise moves the humeral support carriage 26 along the MechanicalHorizontal Axis relative to the radius/ulna support carriage 28 (asFIGS. 22B and 22D show).

The lateral translation mechanical force reduction assembly 34 moves thelateral translation carriage 64 in a horizontal plane along theMechanical Horizontal Axis between the Left Side and Right Side of thefracture reduction fixture 14 to mechanically achieve lateraltranslation along the Anatomical Reduction Horizontal Axis of thefracture reduction coordinate system of the supracondylar region (seeFIG. 15A), as mechanically shown in FIGS. 22B and 22D. This is becausethe proximal bone region, which is held by the humeral support carriedby the Right and Left moving lateral translation carriage 64, is moved,respectively, to the Right and to the Left along the AnatomicalReduction Horizontal Axis relative to the distal fracture region, whichis held in the then-stationary radius/ulna support carriage 28. Thelateral translation mechanical force reduction assembly 34 therebymechanically returns proximal and distal bone regions that have beenmedially displaced along Anatomical Reduction Horizontal Axis backtoward the native state of alignment (as FIG. 14C shows).

b. Mechanically Adjusting and Maintaining Lateral Translation

In the exemplary embodiment, the pace and direction of linear movementof the lateral translation carriage 64 along the mechanical horizontalaxis are incrementally controlled by a lateral translation control knob72 on the Left Side of the fracture reduction assembly 34. The lateraltranslation control knob 72 is coupled to the threaded cross bolt 70,such that rotation of the lateral translation control knob 72 in aclockwise or counterclockwise direction rotates the threaded cross bolt70 in a corresponding direction. The region of the support bed 66 thatrides along the threaded cross bolt 70 is itself helically threaded tomate with the helical threads of the threaded cross bolt 70 to advancethe support bed 66 of the lateral translation carriage 64 along theMechanical Horizontal Axis in precise linear increments in response torotation of the threaded cross bolt 70 (see FIGS. 22C and 22D). Thedesign of the threaded interface between the threaded cross bolt 70 andsupport bed 66 maintains the lateral translation force reductionassembly in a fixed position in the absence of rotation of the lateraltranslation control knob 72. As a further arrangement, the lateraltranslation control knob 72 may be designed to include a lockingmechanism so that it can be extended outwardly or pushed inwardly tofrictionally resist rotation of the lateral translation control knob 72.

As will be exemplified in greater detail later, the lateral translationmechanical force reduction assembly 34 applies mechanical forcereduction to achieve lateral translation, which can be maintained orlocked while other, different mechanical reduction forces are applied bythe system.

iv. Varus/Valgus Rotation Mechanical Force Reduction Assembly

The varus/valgus rotation mechanical force reduction assembly 36mechanically applies and maintains varus/valgus rotation to thefracture. As before described, and as earlier shown in FIGS. 15A to 15D,varus/valgus rotation comprises a rotational force vector (torque)applied about the Anatomic Reduction Perpendicular Axis of the fracturereduction coordinate system of the supracondylar region. Varus/valgusrotation about the Anatomic Reduction Perpendicular Axis pivots thefractured end of the distal bone region about the longitudinal axis ofthe proximal bone region. Varus/valgus rotation returns proximal anddistal bone regions that have been rotationally displaced due to thefracture (as shown in FIG. 10) back toward the native state ofalignment.

Varus/valgus rotation serves to bring back into native alignment theposterior, anterior, and medial cortical surfaces along the fractureline.

a. Mechanically Achieving Varus/Valgus Rotation

In the exemplary embodiment (initially, refer to FIGS. 19A and 19D), thevarus/valgus rotation mechanical force reduction assembly 36 comprises arocking carriage 74 that is structurally coupled to the radius/ulnasupport carriage 28 by the same linkage system 44 that couples thehorizontal traction carriage 42 to the radius/ulna support carriage 28.The rocking carriage 74 and the linkage system 44 by which it is coupledto the radius/ulna support carriage 28 are best shown in FIG. 19D, andare further shaded for identification in FIG. 23A. Like its companionFIGS. 23C and 23D, FIG. 23A also incorporates the directional points ofreference and the principal mechanical axis for varus/valgus rotationestablished in FIG. 19A.

With reference first to FIGS. 19A and 19B, in the exemplary embodiment,it can be seen that the rocking carriage 74 is carried for movementalong a curvilinear track 76. The curvilinear track 76 is formed on asupport base 78 that carries the rocking carriage 74 on the frame 22 ofthe fracture reduction fixture 14. As the rocking carriage 74 is movedalong this curvilinear track 76, the radius/ulna support carriage 28(which is coupled to the rocking carriage 74 by the linkage system 44shaded in FIG. 23A) correspondingly rotates in a rocking motion relativeto the Mechanical Perpendicular Axis in a Leftward or Rightward path(see FIGS. 23A and 23D). The rocking movement of the radius/ulna supportcarriage 28 along this path can also be considered to be “pivoting”about the Mechanical Perpendicular Axis. The rocking movement of theradius/ulna support carriage 28 along this path about the MechanicalPerpendicular Axis in tandem with the rocking carriage 74 is also shownfrom a Free Side perspective in FIG. 23D.

As companion FIG. 23D shows, the varus/valgus rotational mechanicalforce reduction assembly rocks the radius/ulna support carriage 28relative to the Mechanical Perpendicular Axis in a Left direction(Leftward) and Right direction (Rightward).

As FIGS. 23A, 23C, and 23D show, the humeral support carriage 26 is notcoupled to the rocking carriage 74 or to the linkage system 44 that isstructurally coupled it to the radius/ulna support carriage 28. Thehumeral support carriage 26 remains stationary as the rocking carriage74 (and, with it, the radius/ulna support carriage 28) rock Leftward andRightward relative to the Mechanical Perpendicular Axis. As a result,the radius/ulna support carriage 28 rocks Rightward and Leftwardrelative to the stationary humeral support carriage 26 (as FIG. 23Dshows).

The varus/valgus rotation mechanical force reduction assembly 36 rocksthe radius/ulna support carriage 28 Leftward and Rightward relative tothe Mechanical Perpendicular Axis to mechanically achieve varus/valgusrotation about the Anatomic Perpendicular Axis of the fracture reductioncoordinate system of the supracondylar region (see FIG. 15A). By rockingthe radius/ulna support carriage 28 Rightward and Leftward about theMechanical Perpendicular Axis relative to the stationary humeral supportcarriage 26, a rotational force vector (torque) is applied about theMechanical Perpendicular Axis to the fractured end of the distal boneregion (held in the radius/ulna support carriage 28). The varus/valgusrotation force, mechanically applied by the varus/valgus rotationmechanical force reduction assembly 36, pivots the fractured end of thedistal bone region about the Anatomical Perpendicular Axis, to returnthe proximal and distal bone regions, which have been rotationallydisplaced due to the fracture (as shown in FIG. 10), back toward thenative state of alignment (as FIG. 15C shows).

b. Mechanically Adjusting and Maintaining Varus/Valgus Rotation

In the exemplary embodiment (see FIG. 23A), the pace and direction ofmovement of the rocking carriage 74 of the varus/valgus rotationmechanical force reduction assembly 36 along the track are controlled bya varus/valgus control mechanism 80 on the Free Side of the rockingcarriage 74.

In the exemplary embodiment, the varus/valgus control mechanism 80 (alsosee FIG. 23B) includes a control handle 82 and a frictional brake 84carried by the control handle 82. The control handle 82 is pivotallyattached to the rocking carriage 74 for manual movement away from therocking carriage 74 into an unlocked position (i.e., toward the FreeSide, as shown in solid lines in FIG. 23B) and toward the rockingcarriage 74 into a locked position (i.e., toward the Support Side, asshown in phantom lines in FIG. 23B).

When the control handle 82 is in the locked position, the frictionalbrake 84 makes frictional contact with a side of the support base 78, tofractionally resist movement of the rocking carriage 74 along the track76. Conversely, when the control handle 82 is in the unlocked position,the frictional brake 84 is free from frictional contact with a side ofthe support base 78, movement of the rocking carriage 74 along the track76 by external manual force applied by the caregiver or surgeon to thecontrol handle 82 is permitted. The control handle 82 may be elongated,as the exemplary embodiment shows, to provide the caregiver or surgeonwith a lever arm and a mechanical advantage in controlling movement ofthe rocking carriage 74.

By moving the control handle 82 into the unlocked position, the brake 84is disengaged, thereby allowing rocking movement of the radius/ulnasupport carriage 28 Leftward and Rightward relative to the MechanicalPerpendicular Axis by applying a Leftward or Rightward force to thecontrol handle. This provides the previously described rocking movement,which allows the caregiver or surgeon to rock the radius/ulna supportcarrier Left-ward and Right-ward by the application a manual rockingforce upon the rocking carriage 74. When the desired degree ofvarus/valgus rotation is achieved, the caregiver or surgeon moves thecontrol handle 82 into the locked position, thereby engaging thefriction brake 84, to secure the rocking carriage 74 in the desiredposition. The control handle 82 can include a over-center lockingmechanism to resist movement of the control handle 82 out of the lockedposition until a requisite unlocking force is applied to the controlhandle 82.

In the exemplary embodiment, the pace of varus/valgus rotation isincrementally controlled by manual force applied by the surgeon orcaregiver (see FIG. 68) in a macro-condition. In the exemplaryembodiment, there is no micro-condition of varus/valgus rotation, asreducing in this plane typically does not require micro-incrementalalignment.

As will be exemplified in greater detail later, the varus/valgusrotation mechanical force reduction assembly applies mechanical forcereduction to achieve varus/valgus rotational alignment, which can bemaintained by the varus/valgus control handle mechanism, while other,different mechanical reduction forces are applied by the system 10.

v. Pronation/Supination Rotation Mechanical Force Reduction Assembly

The pronation/supination rotation mechanical force reduction assembly 38mechanically applies and maintains pronation/supination rotation to thefracture. As before described, and as earlier shown in FIGS. 16A to 16D,pronation/supination rotation comprises a rotational force vector(torque) applied about the Anatomical Reduction Vertical Axis of thefracture reduction coordinate system of the supracondylar region.Pronation/supination rotation about the Anatomical Reduction VerticalAxis pivots the fractured end of the distal bone region about thelongitudinal axis of distal bone region. Like varus/valgus rotation,pronation/supination rotation returns proximal and distal bone regionsthat have been rotationally displaced due to the fracture (as shown inFIG. 10) back toward the native state of alignment. Pronation/supinationrotation also serves to bring back into native alignment the posterior,anterior, and medial cortical surfaces along the fracture line.

a. Mechanically Achieving Pronation/Supination Rotation

In the exemplary embodiment (initially, referring to FIGS. 19B and 19D),the pronation/supination rotation mechanical force reduction assembly 38comprises a horizontal curvilinear slot 86 on the frame 22 of thefracture reduction fixture 14, along which a guide 88 depending from thesupport base 78 rides (see also FIG. 24C). As the guide 88 follows thepath of the slot 86, the support base 78 itself travels along thecurvilinear path of the slot 86. As the support base 78 travels alongthe slot 86, the radius/ulna support carriage 28 (which is coupled viathe rocking carriage 74 and linkage system to the support base 78) isitself caused to rotate in a swinging motion about an axis that isgenerally parallel to the Mechanical Vertical Axis. The geometric centerof the slot 86 defines a virtual center of rotation for thepronation/supination rotation mechanical force reduction assembly 38,about which the radius/ulna support carriage 28 swings.

The assemblage of components of the pronation/supination rotationmechanical force reduction assembly 38, as just described, is best shownin FIG. 19B. They are further shaded for identification in FIG. 23A.FIG. 23A, like its companion FIGS. 24D and 24E, also incorporate thedirectional points of reference and identify the principal mechanicalaxis for pronation/supination rotation established in FIG. 19A.

As a comparison of FIG. 24E and FIG. 23D show, the pronation/supinationrotation mechanical force reduction assembly 38 (FIG. 24E) causes theradius/ulna support carriage 28 to rotate about an axis that isdifferent than the rocking axis of the radius/ulna support carriage 28brought about by the varus/valgus rotation mechanical force reductionassembly 36 (FIG. 23D). Whereas the varus/valgus rotation mechanicalforce reduction assembly 36 causes the radius/ulna support carriage 28to rock relative to an axis generally parallel to the MechanicalPerpendicular Axis, the pronation/supination rotation mechanical forcereduction assembly 38 causes the radius/ulna support carriage 28 torotate about an axis that is generally parallel to the MechanicalVertical Axis. The pronation/supination rotation mechanical forcereduction assembly 38 establishes a virtual center of rotation for theradius/ulna support carriage 28 (see FIGS. 24A and 24D) that extendsgenerally parallel to the Mechanical Vertical Axis.

The result is the application of rotational force vectors (torques) tothe fracture that substantially differ. The varus/vulgas rotation(rocking relative to the Mechanical Perpendicular Axis) applies arocking force vector to the radius/ulna support carriage 28. Thepronation/supination rotation (rotating relative to the MechanicalVertical Axis) applies a rotating or swinging force vector to theradius/ulna support carriage 28.

The humeral support carriage 26 is not coupled to the support base 78 orthe linkage system 44 that structurally couples it to the radius/ulnasupport carriage 28. The humeral support carriage 26 remains stationaryas the radius/ulna support carriage 28 rotates or swings in thehorizontal plane Leftward and Rightward about the Mechanical VerticalAxis. As a result, the radius/ulna carriage swings Leftward andRightward relative to the stationary humeral support carriage 26 (asFIG. 24D shows).

The pronation/supination rotation mechanical force reduction assembly 38rotates or swings the radius/ulna support carriage 28 about an axisparallel to the Mechanical Vertical Axis to mechanically achievepronation/supination rotation about the Anatomic Vertical Axis of thefracture reduction coordinate system of the supracondylar region (seeFIG. 16A). By rotating or swinging the radius/ulna support carriage 28Rightward and Leftward about the Mechanical Vertical Axis relative tothe stationary humeral support carriage 26, a rotational force vector(torque) is applied about the Mechanical Vertical Axis to the fracturedend of the distal bone region (held in the radius/ulna support carriage28). The pronation/supination rotation force, mechanically applied bythe pronation/supination rotation mechanical force reduction assembly38, pivots the fractured end of the distal bone region about thelongitudinal axis of distal bone region.

b. Mechanically Adjusting and Maintaining Pronation/Supination Rotation

In the exemplary embodiment (see, in particular, FIGS. 24A, 24B and24C), the pace and direction of advancement of the support base alongthe slot 86 are controlled by a pronation/supination control mechanism90 on the Left Side/Bottom of the support base.

In the exemplary example, the pronation/supination control mechanism 90includes a control handle 92 and a frictional brake 94 carried by thecontrol handle 92 (see FIG. 24B). The control handle 92 is pivotallyattached to the support base 78 for manual movement away from thesupport base 78 into an unlocked position (i.e., toward the SupportSide, as shown in solid lines in FIG. 24B) and toward the support base78 into a locked position (i.e., toward the Free Side, as shown inphantom lines in FIG. 24B).

The support base 78 includes a Bottom side that projects below the guide88 (see FIG. 24C). When the control handle 92 is in the locked position,the frictional brake 94 on the Support side of the frame 22 makesfrictional contact with the Bottom side of the support base 78 (shown inphantom lines see FIG. 24B), to resist movement of the support base 78along the slot 86. Conversely, when the control handle 92 is in theunlocked position, the frictional brake 94 is free from frictionalcontact with the Bottom side of the support base 78, and movement of thesupport base 78 along the slot 86 by external manual force applied bythe caregiver or surgeon to the control handle 92 is permitted. Thecontrol handle 92 may be elongated, as the exemplary embodiment shows,to provide the caregiver or surgeon with a lever arm and a mechanicaladvantage in controlling movement of the support base 78.

By moving the control handle 92 into the unlocked position, the brake 94is disengaged, thereby allowing swinging movement of the radius/ulnasupport carriage 28 Leftward and Rightward freely about the MechanicalVertical Axis by applying a Leftward or Rightward force to the controlhandle 92. This provides the previously described swinging movement,which allows the caregiver or surgeon to swing of the radius/ulnasupport carrier Leftward and Rightward by the application a manualswinging force upon the support base 78. When the desired degree ofpronation/supination rotation is achieved, the caregiver or surgeonmoves the control handle 92 into the locked position, thereby engagingthe frictional brake 94, to secure the support base 78 in the desiredposition. The control handle 92 can include an over-center lockingmechanism to resist movement of the control handle 92 out of the lockedposition until a requisite unlocking force is applied to the controlhandle 92.

In the exemplary embodiment, the pace of pronation/supination rotationis incrementally controlled by manual force applied by the surgeon orcaregiver (see FIG. 72) in a macro-condition. In the exemplaryembodiment, there is no micro-condition of pronation/suprinationrotation, as reducing in this plane typically does not requiremicro-incremental alignment.

vi. Flexion/Extension Rotation Mechanical Force Reduction Assembly

The flexion/extension rotation mechanical force reduction assemblymechanically applies and maintains flexion/extension rotation to thefracture. As before described, and as earlier shown in FIGS. 17A to 17D,flexion/extension rotation comprises a rotational force vector (torque)applied about the Anatomical Reduction Horizontal Axis of the fracturereduction coordinate system of the supracondylar region.Flexion/extension rotation about the Anatomical Reduction HorizontalAxis pivots the fractured end of the distal bone region toward thefractured end of the proximal bone region. Flexion/extension rotationreturns the fractures ends of the proximal and distal bone regions thathave been separated due to the fracture back toward the native state ofalignment.

a. Mechanically Achieving Flexion/Extension Rotation

In the exemplary embodiment (initially, refer to FIGS. 19A, 19B, 19E,and 19F), the flexion/extension rotation mechanical force reductionassembly 40 forms a part of the linkage system 44 that couples theradius/ulna support carriage 28 to the horizontal traction carriage 42,vertical traction carriage 54, and the rocking carriage 74.

In the exemplary embodiment (with reference principally to FIG. 19A),the flexion/extension rotation mechanical force reduction assembly 40comprises a first linkage section 96 pivotally connected to thehorizontal traction carriage 42. The first linkage section 96 comprisesa vertical long bar 96A, a vertical short bar 96B, and pivotally coupledcross bars 96C, which together form a first articulating parallelogram.

With continued reference principally to FIG. 19A), the flexion/extensionrotation mechanical force reduction assembly 40 further comprises asecond linkage section 98 pivotally connected to the first linkagesection 96. The second linkage section 98 comprises a horizontal top bar98A and a horizontal bottom bar 98B. The horizontal top bar 98A and thehorizontal bottom bar 98B are coupled on the Support Side to thevertical long bar 96A of the first linkage section 96, and on the FreeSide to the vertical rail 56 supporting the vertical traction carriage54. Together, the second linkage section 98 forms a second articulatingparallelogram.

The first articulating parallelogram 96 and the second articulatingparallelogram 98 couple the horizontal traction carriage 42 to thevertical traction carriage 54, and thereby link the radius/ulna supportcarriage 28 to the parallelograms 96 and 98 that comprise theflexion/extension rotation mechanical force reduction assembly 40.

The assemblage of components of the flexion/extension rotationmechanical force reduction assembly 40, as just described, are shadedfor identification in FIG. 25A. FIG. 25A, like its companion FIGS. 25Band 25C, also incorporate the directional points of reference andidentify the principal mechanical axis for flexion/extension rotationestablished in FIG. 19A.

As shown in FIG. 25C, due to the interconnected first and secondparallelograms 96 and 98 that form the flexion/extension rotationmechanical force reduction assembly 40, the radius/ulna support carriage28 can be tilted about the Mechanical Horizontal Axis in the directionof the Free Side or in the direction of the Support Side of the fracturereduction fixture 14. More particularly, the radius/ulna supportcarriage 28 can be tilted from a normal, upright position (see FIG.25B), toward the Free Side or toward the Support Side (see FIG. 25C).

As a comparison of FIGS. 25C, 24E, and 23D show, the flexion/extensionrotation mechanical force reduction assembly 40 (FIG. 25C) causes theradius/ulna support carriage 28 to tilt about an axis that is differentthan the swinging axis of radius/ulna support carriage 28 brought aboutby the pronation/supination rotation mechanical force reduction assembly38 (FIG. 24E), and that is different than the rocking axis of theradius/ulna support carriage 28 brought about by the varus/valgusrotation mechanical force reduction assembly 36 (FIG. 23D). Whereas theflexion/extension rotation mechanical force reduction assembly 40 causesthe radius/ulna support carriage 28 to tilt relative to an axisgenerally parallel to the Mechanical Horizontal Axis, thepronation/supination rotation mechanical force reduction assembly 38causes the radius/ulna support carriage 28 to swing about an axis thatis generally parallel to the Mechanical Vertical Axis, and thevarus/valgus rotation mechanical force reduction assembly 36 causes theradius/ulna support carriage 28 to rock relative to an axis generallyparallel to the Mechanical Perpendicular Axis.

The result is the application of rotational force vectors (torques) tothe fracture that substantially differ. The flexion/extension rotationmechanical force reduction assembly 40 (tilting relative to theMechanical Horizontal Axis) applies a tilting force vector to theradius/ulna support carriage 28. The pronation/supination rotation(rotating relative to the Mechanical Vertical Axis) applies a rotatingor swinging force vector to the radius/ulna support carriage 28. Thevarus/vulgas rotation (rocking relative to the Mechanical PerpendicularAxis) applies a rocking force vector to the radius/ulna support carriage28.

The humeral support carriage 26 is not coupled to the linkage system 44coupled to the radius/ulna support carriage 28. The humeral supportcarriage 26 remains stationary as the radius/ulna support carriage 28tilts toward the Free Side or toward the Support Side. As a result, theradius/ulna support carriage 28 tilts relative to the stationary humeralsupport carriage 26 (as FIG. 25C shows).

The flexion/extension rotation mechanical force reduction assembly 40tilts the radius/ulna support carriage 28 about an axis parallel to theMechanical Horizontal Axis to mechanically achieve flexion/extensionrotation about the Anatomical Reduction Horizontal Axis of the fracturereduction coordinate system of the supracondylar region (see FIG. 17A.By tilting the radius/ulna support carriage 28 relative to thestationary humeral support carriage 26, a rotational force vector(torque) is applied about the Mechanical Horizontal Axis to thefractured end of the distal bone region (held in the radius/ulna supportcarriage 28). The flexion/extension rotation force, mechanically appliedby the flexion/extension rotation mechanical force reduction assembly40, pivots the fractured end of the distal bone region toward thefractured end of the proximal bone region. Flexion/extension rotationreturns the fractured ends of the proximal and distal bone regions thathave been separated due to the fracture back toward the native state ofalignment.

b. Mechanically Adjusting and Maintaining Flexion/Extension Rotation

In the exemplary embodiment (see FIG. 19B), flexion/extension achievedby tilting the radius/ulna support carriage 28 is controlled by aflexion/extension control mechanism 100 on the Right Side of thefracture reduction assembly 40.

In the exemplary embodiment, the flexion/extension control mechanism 100includes a threaded locking pin 102 that can be advanced by rotationinto the vertical short bar 96B and Bottom-most cross bar 96C of thefirst linkage section 96 of the flexion/extension mechanical forcereduction assembly 40. A control knob 104 on the exposed end of thelocking pin 102 allows the caregiver or surgeon to rotate the lockingpin 102 clockwise or counterclockwise.

By rotating the locking pin 102 clockwise, the locking pin 102 causesthe vertical short bar 96B and the Bottom-most cross bar 96C tofrictionally interfere. The frictional interference prevents tiltingarticulation of the first and second parallelograms 96 and 98 of theflexion/extension mechanical force reduction assembly 40.

Conversely, by rotating the locking pin 102 counterclockwise, frictionalinterference between the vertical short bar 96B and the Bottom-mostcross bar 96C is freed. The absence of frictional interference allowsthe caregiver or surgeon to tilt the first and second parallelograms 96and 98 to achieve a desired amount of flexion/extension rotation, byapplying force to the Free Side of the second parallelogram 98, e.g., byholding the vertical traction carriage 54 and applying force toward theFree Side or Support Side, as desired. This can be seen in FIG. 25C.When the desired amount of flexion/extension is achieved, the caregiveror surgeon can rotate the locking pin 102 clockwise, to maintain thedesired flexion/extension. The frictional interference maintains thethen-present tilted, torque-applying position of the radius/ulna supportcarriage 28, to maintain the then-present degree of flexion/extensionrotation.

In the exemplary embodiment, the pace of flexion/extension rotation isincrementally controlled by manual force applied by the caregiver orsurgeon (see FIG. 76) in a macro-condition. In the exemplary embodiment,there is no micro-condition of flexion/extension rotation, as reducingin this plane typically does not require micro-incremental alignment.

As will be exemplified in greater detail later, the flexion/extensionrotation mechanical force reduction assembly 40 applies mechanical forcereduction to achieve flexion/extension rotational alignment, which canbe maintained by the flexion/extension control mechanism, while other,different mechanical reduction forces are applied by the system.

V. Systems and Devices for Mechanically Fixing a Bone Fracture FollowingReduction

A. Overview

Illustrative devices and systems 10 for achieving a mechanical forcereduction of a fracture have been described, for the purpose ofillustration, in the context of reducing a supracondylar fracture. Thedevices and systems 10 mechanically reduce the fracture by theapplication of one or more mechanical force vectors to return boneregions separated and displaced by the fracture back toward a nativestate of alignment, i.e., that which existed prior to the fracture.

Next to be described are illustrative devices and systems 200 formechanically “fixing” the fracture following its reduction. As usedherein, the terms “mechanical” and “mechanism” broadly connote thepresence of one or more tools or instruments that guide the insertion ofa bone fixing device. In this respect, the terms “mechanical” and“mechanism” as used herein apply not only to the use of “machines” inthe traditional sense (e.g., with components such as axles, bearings,gears, linkages, springs, wheels, pulleys, motors, engines, compressors,pumps, pistons, and the like, interacting alone or in combination togenerate and apply kinetic force), but also to any tool or instrumentthat guides the insertion of a bone fixing device using, e.g.,electrical and/or electro-mechanical components, and/or pneumaticcomponents, and/or hydraulic components, and/or electronic components,and/or mechatronic components, and/or nanotechnology components, and canalso incorporate, e.g., robotics, automation, and/or computer control.

The systems 200 mechanically “fix” a reduction by providing one or morebone fixing instruments or tools into the region of the reduced bonefracture. The bone fixing instruments or tools provide systematicmechanical guidance for the placement of bone fixing devices 202 such aspins or rods (see, e.g., FIG. 31B), which secure the bone regionstogether in the desired anatomic orientations achieved by reduction. Thebone fixing devices 202 stabilize the anatomic orientations of thereduction, thereby preventing the reduced bone regions from moving outof reduction alignment as healing occurs.

The systems 200 and the mechanical instruments or tools and methods theyincorporate for fixing a fracture reduction, as will be described, areapplicable to all bone fractures, simple or complex, in children oradults, and involving all bone types, including, e.g., in the arm,involving the humerus and/or forearm and/or wrist; in the leg, involvingthe tibia and/or fibula; and at, in, or near articulating condyles (alsocalled a condylar fracture), e.g. at, in, or near the elbow, or at, in,or near the knee. Still, as before explained, the technical features ofthe systems 200 can be well exemplified and highlighted with respect tothe fixing of supracondylar fractures of the elbow. For this reason, thesystems 200 and the instruments, tools, systems, and methods theyincorporate will be described in this context. Nevertheless, it is to beappreciated that the systems 200 are not restricted to supracondylarapplications. It is to be appreciated that the disclosed instruments,the systems 200 and the devices, instruments, and methods theyincorporate are readily applicable for use in treating all types of bonefractures, simple or complex, of any bone type, in children or adults,anywhere in the body.

In the illustrative embodiments, the systems 200 for mechanically fixingthe reduced bone fracture are shown in association with the systems 10for mechanically reducing the bone fracture in the first instance. Forexample, FIGS. 29, 30, 31A, 31B, and 32 show a bone fixing system 200 inassociation with the mechanical fracture reduction fixture 14 or srepresentative system 10.

The integration of devices and systems for mechanically reducing andfixing a bone fracture is desirable, but not essential. The systems anddevices for mechanically reducing a bone fracture in the first instance,and then fixing the reduced bone fracture in the second instance cancomprise separate, free-standing units, or, as will be shown, integratedinto assemblies having complementing, dual functionality.

In use, both bone reduction and bone reduction fixing are desirablyperformed using conventional radiation imaging techniques. This isillustrated in FIGS. 46A/B and FIGS. 47A/B. FIG. 46A shows an individualhaving a supracondylar fracture lying in a supine position fortreatment. For treatment of a supracondylar fracture, as has beenpreviously described, the humerus of the individual is laterallyextended from the shoulder and the radius/ulna is flexed at the elbow topoint the hand in a superior direction facing the shoulder. Theorientation of the individual's humerus and radius/ulna can bemaintained, e.g., by the humeral support carriage 26 and the radius/ulnasupport carriage 28 of the mechanical fracture reduction fixture 14, ashas been and will be described in greater detail later.

Conventional radiation imaging techniques include a c-arm 272 thatapplies radiation through the fracture region to create a viewableradiographic image of the orientation of the bone structures. The c-arm272 can be oriented relative to the fracture region in a horizontalplane (as shown in FIG. 46A), to provide a lateral view of the fractureregion, which is shown in FIG. 46B. The c-arm 272 can also be swung intoa generally vertical plane with respect to the fracture region (as shownin FIG. 47A) to provide an anterior-to-posterior (a-p) view of thefracture region, which is shown in FIG. 47B. The use of the radiographiclateral and a-p views during mechanical force reduction will be furtherdescribed in greater detail later. First, there will be a description ofthe structural form and function of representative devices and systemsfor mechanically “fixing” the fracture following its reduction, whichalso relies upon use of the radiographic lateral and a-p views justdescribed.

B. Pin Guide Assembly

As has been described, a system 200 is provided for fixing a reducedbone fracture. In a representative embodiment, the system 200 comprisesa frame 204 that is sized and configured to support a reduced bonefracture of an individual. The system 200 also comprises a pin guideassembly 206 on the frame that includes a bone fixing device guide 208.The bone fixing device guide 208 defines a guide path along which a bonefixing device 202 can be advanced into a region of the reduced bonefracture. The pin guide assembly 206 includes a linkage system 212 thatcouples the bone fixing device guide 208 to the frame 14 forarticulation of the guide path among a plurality of desired orientationswith respect to the reduced bone fracture.

FIGS. 27 to 35 show an exemplary structural embodiment of a pin guideassembly 206 for fixing a fracture following its reduction. The pinguide assembly 206 establishes and maintains, by mechanical means, adesired path for advancement of a bone fixing device 202—independentlyin different planes—prior to advancement of the bone fixing device 202,e.g. pin, into a reduced bone fracture. The technical features andbenefits of the pin guide assembly 206 will be described for the purposeof illustration in the context of fixing a reduced supracondylarfracture, but the technical features that will be described areapplicable to fixing reduced bone fractures, simple or complex, of allbone types, in children or adults.

FIGS. 27 and 28 show the pin guide assembly 206 prior to its associationwith a fractured bone region. FIGS. 29 to 31A and 32 show the pin guideassembly 206 in association with a fracture reduction fixture 14 of thetype previously described. In the exemplary embodiment, the fracturereduction fixture 14 includes a circular fixing alignment rail 214, onwhich the pin guide assembly 206 is mounted for use.

FIGS. 27 to 31A have been annotated to provide baseline directionalpoints of reference for the purpose of describing the exemplaryembodiment of the pin guide assembly 206. The baseline directionalpoints of reference are from the point of view of a caregiver or surgeonfacing the Free Side of the fracture reduction fixture 14 after mountingof the pin guide assembly 206 on the mid-point of the circular fixingalignment rail.

From this perspective, the pin guide assembly 206 can be seen to have aTrack (i.e., Rail) Side, which, in use, faces in the direction of thecircular fixing alignment rail on the Free Side of the fracturereduction fixture 14, and an Arm Side, which, in use, faces in theopposite direction toward the fractured arm held by the fracturereduction fixture 14. From this perspective, the baseline directionpoints of reference also include a Left Side, a Right Side, a Top, and aBottom, relative to the view of the surgeon or caregiver facing thecircular fixing alignment rail 214 on the Free Side of the fracturereduction fixture 14.

As was the case for the fracture reduction fixture 14, the orientationof the Left and Right Sides of the pin guide assembly 206 relative tothe head and feet of the patient when in use will vary depending uponwhether the supracondylar fracture is in the patient's the right arm orin the patient's left arm. For a right arm fracture, the Left Side ofthe pin guide assembly 206 faces the patient's head. For a left armfracture, the Right Side of the pin guide assembly 206 faces thepatient's head. FIGS. 29 to 31A are based upon a right arm fracture.

1. The Shuttle Body

The pin guide assembly 206 includes at its Bottom-most a shuttle body216 (see also FIG. 32). The shuttle body 216 is sized and configured tobe adjustably located relative to a bone region having a fracture thathas been reduced. The shuttle body 216 includes a shuttle mount 218 thatis sized and configured to slide or travel along the circular fixingalignment rail 214 provided on the fracture reduction fixture 14. Theshuttle mount 218 of the shuttle body 216 permits the shuttle body 216to be manually positioned at an infinite number of positions from LeftSide to Right Side along the fixing alignment rail 214. As will bediscussed later, the fixing alignment rail 214 assists in properradiograph alignment when carrying out the described procedures.

A shuttle locking screw 220 can be tightened by rotation in onedirection to establish frictional interference between the shuttle mount218 and fixing alignment rail 214, thereby preventing travel along thefixing alignment rail 214 and preserving the then-established positionof the shuttle body 216. The shuttle locking screw 220 can be loosenedby rotation in an opposite direction to remove frictional interferencebetween the shuttle mount 218 and the fixing alignment rail 214, therebyallowing free travel of the shuttle body 216 along the fixing alignmentrail 214 for repositioning.

2. The Bone Fixing Device Guide

The pin guide assembly 206 includes at its Top-most the bone fixingdevice guide 208. The pin guide assembly 206 shown in FIGS. 27, 28, and32 includes a guide channel 222 (see FIG. 35). The guide channel 222defines a path along which a conventional bone fixing device 202 can bemanually advanced through the pin guide assembly 206 by a caregiver orsurgeon.

The bone fixing device 202 comprises a thin rod (or pin) having asharpened leading tip for penetrating skin and bone during advancement.The bone fixing device 202 includes a radio-opaque material, so that theorientation of the bone fixation device relative to the reduced bonestructures can be concurrently viewed by radiation imaging.

(i) Sterile Guide Bushing

In a representative embodiment, the system 200 comprises a guide bushing224 that includes a bushing channel 226 for passing a bone fixing device202. As will be described in greater detail later, the guide bushing 224is sized and configured to be handled separate from the guide assemblyfor insertion into the guide channel 222 of the bone fixing device guide208 at the instance of use and for separation from the guide path afteruse. In this arrangement, the system includes packaging that maintainsthe guide bushing 224 in a sterile condition prior to insertion into theguide path.

In the exemplary embodiment (see FIGS. 33A to 35), the bone fixingdevice guide 208 is sized and configured to receive during use the guidebushing 224 as a sterile, single use, disposable item. The guide bushing224 is elongated to be inserted into the guide channel 222 of the bonefixing device guide 208 (see FIG. 35) at the instance of use. The guidebushing 224 also includes a collar 228 that allows the guide bushing 224to be grasped at its periphery, away from the bushing channel 226, andalso serves as a stop to limit the length of insertion of the guidebushing 224 through the guide channel 222.

The bushing channel 226 of the guide bushing 224 includes an entranceend 230 (see FIG. 33A) for receiving the bone fixing device 202 forpassage. The entrance end 230 desirably comprising a funnel shapedentrance surface 232 that directs the bone fixing device 202 directlyinto the bushing channel 226. In this arrangement, the funnel shapedentrance surface 232 shields the bushing channel 226 from inadvertentcontact and loss of sterility prior to use, e.g. by a caregiver orsurgeon or a person setting up the pin guide assembly 206.

As FIG. 34 shows, the guide bushing 224 is intended to be supplied tothe caregiver or surgeon separate from the pin guide assembly 206 in asterilized condition within a sealed, sterile pouch or packaging 234.The caregiver or surgeon removes the guide bushing 224 from thepackaging 234 when desired and mounts it in the guide channel 222 of thebone fixing device guide 208 as a sterile component. Its insertion canbe delayed during set-up and pre-insertion manipulation of the pin guideassembly 206, up to the particular moment that insertion of the bonefixing device 202 is desired.

The guide bushing 224 can thereby remain in a sterile condition withinthe sterile pouch or packaging 234 right up to the instance of use.During use, the bone fixing device 202 comes into contact only with theinward facing tapered surface 232 (funnel) of the guide bushing 224,which protects the sterility of the bushing channel 226 and minimizesthe chance that the bone fixing device 202 will contact a non-sterileenvironment prior to its inserting into the fracture site. After use,the guide bushing 224 can be removed from the pin guide assembly 206and, if desired, disposed of. Alternatively, the guide bushing 224 canbe re-sterilized and packaged again in a sterile condition for reuse ina later procedure.

The modular, sterile, and desirably single use guide bushing 224 makespossible the sterile insertion of a bone fixing device 202 using the pinguide assembly 206, without the need to sterilize the entire pin guideassembly 206. During use, the bone fixing device 202 need only contactthe protected sterile receiving end 230 of the guide bushing 224.Sterilization requirements are thereby limited to the guide bushing 224,and not the overall pin guide assembly 206. After use, the guide bushing224 can be removed from the pin guide assembly 206 and, as desired,disposed of or re-sterilized.

3. The Orientation Linkage System

Referring mostly to FIG. 32, the shuttle body 216, riding on the shuttlemount 218, is coupled to the bone fixing device guide 208 by a stackedarray of additional mounts or links comprising a bone fixing linkagesystem 236. In a representative embodiment, the bone fixing linkagesystem 236 includes a first linkage that articulates the bone fixingdevice guide 208 in a first plane, and includes a mechanism that issized and configured to mechanically interact with the first linkage tomaintain a desired articulation in the first plane. The bone fixinglinkage system 236 also desirably includes a second linkage thatarticulates the bone fixing device guide 208 in a second plane differentthan the first plane, and includes a mechanism that is sized andconfigured to mechanically interact with the second linkage to maintaina desired articulation in the second plane, without altering the desiredarticulation in the first plane. The bone fixing linkage system 236 canalso include at least one additional linkage that articulate the bonefixing device guide 208 in a third plane that intersects one of thefirst and second planes at an angle, and includes a mechanism that issized and configured to mechanically interact with the additionallinkage to maintain a desired articulation in the third plane, withoutaltering the desired articulations in the first and second planes.

The independent linkages of the of bone fixing linkage system 236 allowsindependent orientation of the bone fixing device guide 208 relative tothe reduced fracture in different planes, including a horizontal plane(i.e., generally along the Mechanical Horizontal or Perpendicular Axesof the associated fracture reduction fixture 14), a vertical plane(i.e., generally along the Mechanical Vertical Axis of the associatedfracture reduction fixture 14), and one or more planes that intersect ahorizontal or vertical plane at an angle (which can also be called an“angular plane”). Within each plane, the bone fixing linkage system 236allows the surgeon or caregiver or surgeon to hold stationary a desiredorientation in one plane, and to proceed with orientation in anotherplane without altering any preceding orientation.

(i) Left and Right Translation Within the Horizontal Plane

In a representative structural implementation, the bone fixing linkagesystem 236 comprises a first link bar or mount 238. The first link bar238 is coupled to the shuttle body 216 within a first channel 240 thatextends parallel to the fixing alignment rail 214 in a Right-ward andLeft-ward direction in the orientation shown in FIG. 32. The firstchannel guides lateral movement (i.e., translation) of the first linkbar 238 relative to the mount in a Right-ward and Left-ward directionwithin the horizontal plane. The bone fixing linkage system 236transmits this track of lateral movement or translation to the bonefixing device guide 208. The first channel 240 permits the first linkbar 238 to be manually positioned at an infinite number of positionsalong the first channel 240. Frictional engagement between the firstchannel 240 and first link bar 238 can be established (e.g., by a setscrew 242) that holds stationary the then-established position of thefirst link bar 238 within the first channel 240. Release of thefrictional engagement allows repositioning by the further application ofa translational force by the caregiver or surgeon.

(ii) Track Side and Arm Side Translation Within the Horizontal Plane

The bone fixing linkage system further comprises a second link bar ormount 244. The second link bar 244 is coupled to the first mount 218within a second channel 246 in the first link bar 238 that extendsperpendicular to the first channel 240 in a Track Side and Arm Sidedirection in the orientation shown in FIG. 32. The second channel 246guides linear movement (i.e., translation) of the second link bar 244relative to the mount in a Track Side and Arm Side direction within thehorizontal plane. The bone fixing linkage system 236 transmits thistrack of linear movement to the bone fixing device guide 208. The secondchannel 246 permits the second link bar 244 to be manually positioned atan infinite number of positions along the second channel 246. Frictionalengagement between the second channel 246 and the second link bar 244can be established (e.g., by a set screw 248) that holds stationary thethen-established position of the second link bar 244 within the secondchannel 246. Release of the frictional engagement allows repositioningby the further application of a translational force by the caregiver orsurgeon.

If desired, the second link bar or mount 244 can be rigidly attached tothe first link bar or mount 238, i.e., without accommodating Track Sideand Arm Side translation. This is because the bone fixing device 202itself can be translated in a Track Side to Arm Side direction foralignment purposes.

(iii) Top-Ward and Bottom-Ward Translation Within the Vertical Plane

The bone fixing linkage system 236 further comprises a third link bar ormount 250 that is coupled to the second link bar 244 within a thirdchannel 252 in the second link bar 244 that extends perpendicular to thesecond channel 246 in a Top-ward and Bottom-ward direction in theorientation shown in FIG. 32. The third channel 252 guides linearmovement (i.e., translation) of the third link bar 250 relative to themount in a Top-ward and Bottom-ward direction within the vertical plane.The bone fixing linkage system 236 transmits this track of linearmovement to the bone fixing device guide 208. The third channel 252permits the third link bar 250 to be manually positioned at an infinitenumber of positions along the third channel 252. Frictional engagementbetween the third channel 252 and third link bar 250 can be established(e.g., by a set screw 254) that holds stationary the then-establishedposition of the third link bar 250 within the third channel 252. Releaseof the frictional engagement allows repositioning by the furtherapplication of a translational force by the caregiver or surgeon.

(iv) Left-Ward and Right-Ward Rotation Within the Horizontal Plane

The bone fixing linkage system 236 further comprises a fourth link baror mount 256. The fourth link bar 256 is rigidly coupled to the Top ofthe third link bar 250. The fourth link bar 256 secured to the Top ofthe third link bar 250 in a Right-ward and Left-ward orientation, asshown in FIG. 32. The fourth link bar 256 is curvilinear, having acurvature from Left to Right, in the orientation shown in FIG. 32, whichgenerally coincides with the curvature of the fixing alignment rail 214.The curvilinear axis of the fourth link bar 256 also extends parallel tothe linear axis of the first link bar 238. The fourth link bar 256includes an elongated horizontal through slot 258, which extends in acurvilinear Free-ward and Left-ward direction in the orientation shownin FIG. 32. A follower 260 rides in the slot 258 in a curvilinearRight-ward and Left-ward direction in the orientation shown in FIG. 32.The slot 258 guides curvilinear movement (i.e., rotational) of thefollower 260 along the fourth link bar 256 in a curved Right-ward andLeft-ward trajectory within the horizontal plane. The bone fixinglinkage system 236 transmits this track of rotational movement to thebone fixing device guide 208. The slot 258 permits the follower 260 tobe manually positioned, within the horizontal confines of the slot 258,at an infinite number of positions along this trajectory. A followerlocking screw 262 can be tightened by rotation in one direction toestablish frictional interference between the slot 258 and the follower260, thereby preventing travel along the slot 258 and preserving thethen-established position of the follower 260. The follower lockingscrew 262 can be loosened by rotation in an opposite direction to removefrictional interference between the slot 258 and the follower 260,thereby allowing free travel of the follower 260 trajectory forrepositioning the bone fixing device guide 208.

(v) Top-Ward and Bottom-Ward Rotation Within the Vertical Plane

The bone fixing linkage system 236 further comprises a fifth link bar ormount 264. The fifth link bar 264 is rigidly coupled to the Arm Side ofthe follower 260, extending in a Top-ward direction, in the orientationshown in FIG. 32. The fifth link bar 264 is curvilinear, having acurvature from Bottom to Top which generally matches the curvature ofthe fourth link bar 256 from Right to Left. The fifth link bar 264includes an elongated vertical slot 266, which extends in a curvilinearTop-ward direction in the orientation shown in FIG. 32. The bone fixingdevice guide 208 rides in the slot 266 in a curvilinear Top-warddirection in the orientation shown in FIG. 32. The slot 266 guidescurvilinear movement (i.e., rotational) of the bone fixing device guide208 along the fifth link bar 264 in a Top-ward trajectory within thevertical plane. The Top-ward trajectory orients the guide channel 222 ofthe bone fixing device guide 208 along planes that intersect thehorizontal or vertical plane at an angle (i.e., angular planes). TheTop-ward trajectory (beginning that the Bottom of the slot 266 andmoving to the Top of the slot 266) will orient the guide channel 222 ofthe bone fixing device guide 208 along angular planes that direct thebone fixing device 202 Top-ward, then horizontal, and then Bottom-ward.The slot 266 permits the bone fixing device guide 208 to be manuallypositioned, within the vertical confines of the slot 266, at an infinitenumber of positions along this trajectory. A guide locking screw 268 canbe tightened by rotation in one direction to establish frictionalinterference between the slot 266 and the bone fixing device guide 208,thereby preventing travel along the slot 266 and preserving thethen-established position of the bone fixing device guide 208. The guidelocking screw 268 can be loosened by rotation in an opposite directionto remove frictional interference between the slot 266 and the bonefixing device guide 208, thereby allowing free travel of the bone fixingdevice guide 208 along the trajectory for repositioning the guide 208.

As FIG. 32 shows, the vertical distance (Top-ward and Bottom-ward)between the bone fixing device guide 208 and the shuttle body 216 (andthe fixing alignment rail 214 itself) can be manually adjusted in bothvertical translational and vertical rotational tracks. By moving thethird link bar 250 Top-ward and Bottom-Ward, vertical translation can beachieved and maintained. By moving the bone fixing device guide 208along the slot 266 within the fifth link bar 264 in a Top-warddirection, a vertical rotation (trajectory) can be achieved andmaintained.

As FIG. 32 also shows, the horizontal distance (Track-ward and Arm-ward)between the bone fixing device guide 208 and the shuttle body 216 (andthe fixing alignment rail 214 itself) can be manually adjusted in ahorizontal translational track. By moving the second link bar 244Track-ward and Arm-Ward, horizontal translation can be achieved andmaintained.

As FIG. 32 also shows, the horizontal offset (lateral) distance(Right-ward and Left-ward) between the bone fixing device guide 208 andthe shuttle body 216 (and the fixing alignment rail 214 itself) can bemanually adjusted in both lateral translational and lateral rotationaltracks. By moving the first link bar 238 Right-ward and Left-ward,lateral translation can be achieved and maintained. By moving theshuttle body 216 along the fixing alignment rail 214, a macro-degree oflateral rotation (trajectory) can be achieved and maintained. By movingthe follower 260 along the slot 258 within the fourth link bar 256, amicro-degree of horizontal rotation (trajectory), finer than themacro-degree, can also be achieved and maintained.

(vi) A-P Guide Pin

The follower 260 of the fourth link bar 256 also accommodates an a-pguide pin 270 positioned in a stationary position vertically below thebone fixing device guide 208 (i.e., vertically Bottom-ward of the guide208, through which the bone fixing device 202 is advanced) (see FIGS.27, 28, 29, and 32). In this exemplary embodiment, the a-p guide pin 270is also positioned outside the body region vertically above the shuttlebody 216 (i.e., vertically Top-ward of the shuttle body 216). The a-pguide pin 270 includes a radio-opaque material, so that the orientationof the a-p guide pin 270 can be visualized by radiographic imaging (seeFIGS. 30A and 30B). The a-p guide pin 270 extends along a horizontalaxis that is parallel to and axially aligned with (i.e., in the samevertical plane as) the axis of the path along which the bone fixingdevice 202 is manually advanced by a caregiver or surgeon.

Due to this purposeful alignment, when the c-arm 272 is oriented in avertical plane (shown in FIGS. 30A and 30B), the radiographic a-p viewwill include the image of the a-p guide pin 270 (see FIGS. 30A and 30B).As the bone fixing device 202 is manually advanced by a caregiver orsurgeon into the view, the image of the bone fixing device 202 willcoincide with the image of the a-p guide pin 270, as FIG. 30B shows.Translational and rotational adjustment of the guide pin 270 establishesa desired path of placement for the bone fixing device 202, prior toactual insertion of the bone fixing device 202, aided by a-pradiographic monitoring of the position of a-p guide pin 270.

VI. The Orthotic Brace

FIG. 36 shows an exemplary embodiment of an orthotic brace 300, which issized and configured to be fully or partially assembled and fitted to aregion or regions of a bone fracture prior to, during, or after fracturereduction and/or fixing. The orthotic brace 300 helps to maintain and/orimprove the reduction, after fixing, while healing occurs. The orthoticbrace 300 performs this function by controlling, guiding, limitingand/or immobilizing the reduction after fixing; and/or restrictingmovement in a given direction; and/or reducing weight bearing forces;and/or otherwise maintain the orientation of the bone structures afterreduction and fixing.

The orthotic brace 300 can be made from various types of materials knownin the orthotics field, e.g., plastic, elastic, metal, or a combinationof similar materials.

The orthotic brace 300 can be sized and configured to be integrated intomechanical fracture reduction and fixing systems and methods, e.g., byaccommodating temporary securing of the orthotic brace 300 to a humeralsupport carriage 26 and a radius/ulna support carriage 28 associatedwith a mechanical bone reduction fixture 14, either fully or partiallyassembled to the region of fractured bone, to thereby reside on thefixture 14 while mechanical reduction is achieved and/or reside on thefixture 14 while mechanical reduction fixing is achieved. Afterreduction and fixing, the orthotic brace 300 is sized and configured tobe removed from the system, to be thereafter worn by the individual,fully assembled to the fixed reduction, to maintain and/or improve thefixed reduction while healing occurs.

The orthotic brace 300 and associated systems and methods that will bedescribed are applicable to all bone fractures, simple or complex, inchildren or adults, and involving all bone types, including, e.g., inthe arm, involving the humerus and/or forearm and/or wrist; in the leg,involving the tibia and/or fibula; and at, in, or near articulatingcondyles (also called a condular fracture), e.g. at, in, or near theelbow, or at, in, or near the knee. Still, as before explained in thecontext of previous descriptions, the technical features of the orthoticbrace 300 and associated systems and methods can be well exemplified andhighlighted with respect to the fixing of supracondylar fractures of theelbow. For this reason, the orthotic brace 300 and associated systemsand methods will be described in this context. Nevertheless, it is to beappreciated that the orthotic brace 300 and associated systems andmethods that embody features of the invention are not restricted tosupracondylar applications. It is to be appreciated that the disclosedorthotic brace 300 and associated systems and methods are readilyapplicable for use in treating all types of bone fractures, simple orcomplex, of any bone type, in children or adults, anywhere in the body.

As shown in FIG. 36, the orthotic brace 300 is sized and configured fortreating a supracondylar fracture. In this context, the orthotic brace300 includes a humeral brace component 302 and a radius/ulnar bracecomponent 304. In use, see FIG. 37, the humeral brace component 302 issecured to the humerus, e.g., by straps, to hold the humerus in alaterally extended position from the shoulder. The radius/ulnar bracecomponent 304 is secured to the radius/ulna, e.g. by straps, to hold theradius/ulna while flexed at the elbow to point the hand in a superiordirection facing the shoulder.

Struts 306 coupled to the humeral brace component 302 and theradius/ulna brace component 304 (see FIG. 36) allow relative movement ofthe humeral brace component 302 vertically, relative movement of theradius/ulnar brace component 304 horizontally, and relative flexure andextension of the humeral brace component 302 and the radius/ulnar bracecomponent 304. Fasteners 308 on the struts 306 make it possible to lockthe relative positions of the humeral brace component 302 and theradius/ulnar brace component 304 horizontally, vertically, and inflexure/extension to hold fast the reduction forces applied to thefracture.

The exemplary fracture reduction fixture 14 previously describedincludes a humeral support carriage 26 and a radius/ulna supportcarriage 28, which can be sized and configured to carry the humeralbrace component 302 and the radius/ulnar brace component 304. In thisway, the fracture reduction fixture 14 and orthotic brace 300 worktogether to collectively hold the humerus and radius/ulna in the desiredorientation during mechanical reduction, and to maintain thisorientation during and after reduction, while the reduction ismechanical fixed. It can be appreciation that the form, fit, andfunction of the humeral brace component 302 and the radial/ulnar bracecomponent 304 complement the form, fit, and function of the humeralsupport carriage 26 and the radius/ulna support carriage 28 of themechanical fracture reduction fixture 14. For this reason, the orthoticbrace 300 can be sized and configured to be partially or fully assembledto a region or regions of the fracture and be temporarily secured, e.g.,by straps, pins, or fasteners, to the humeral support carriage 26 andthe radius/ulna support carriage 28 of the reduction frame prior tomechanical force reduction (as FIG. 37 shows). The orthotic brace 300can likewise be sized and configured, while partially or fully assembledto a region or regions of the fracture, to remain secured to the humeralsupport carriage 26 and the radius/ulna support carriage 28 duringfixing of the reduced fracture. This technical feature will be describedin further detail and shown in subsequent figures.

After fixing of the mechanically reduced fracture, the orthotic brace300 is released from the fracture reduction fixture 14 fully assembledto the individual's arm (see FIG. 38), to be worn by the individual tomaintain and/or improve the reduction, after fixing, while healingoccurs.

FIGS. 39 to 45B depict another (also referred to as being the “second”)exemplary embodiment of an orthotic brace 310. In this exemplaryembodiment, as will be described in greater detail later, the orthoticbrace 310 includes a proximal brace component 312 that is sized andconfigured to be fitted to a proximal region of the fracture, and adistal brace component 314 that is sized and configured to be fitted toa distal region of the fracture.

The second orthotic brace 310 can be made from various types ofmaterials known in the orthotics field, e.g., plastic, elastic, metal,or a combination of similar materials.

The second orthotic brace 310 may also be fitted with an expandable foammaterial, which can expand and contract once a fracture is reduced andfixed. The expandable foam material will allow the orthotic brace 310 tosecurely retain the fracture post-operation when swelling of thefracture region may occur.

The orthotic brace 310 in this exemplary embodiment also includes astrut 316 having a proximal region linked to the proximal bracecomponent 312 and a distal region linked to the distal brace component314. In this exemplary embodiment, at least one of the proximal anddistal regions comprises a linkage mechanism 318 permitting articulationof the respective brace component 312/314 on the strut 316 within arange of rotational orientations to accommodate forces applied to reducethe fracture. These are generally shown by directional arrows in FIGS.42A and 42B. The respective region further includes a locking mechanism320 to maintain a desired rotational orientation within the range tomaintain a desired reduction of the fracture.

In a desirable implementation (as shown in FIGS. 42A and 42B), both theproximal and distal regions comprise a linkage mechanism 318 permittingarticulation of the respective brace component on the strut 316 within arange of rotational orientations in response to forces applied to reducethe fracture. In this arrangement, each proximal and distal regionfurther includes a locking mechanism 320 to maintain a desiredrotational orientation for each brace component within the range tomaintain a desired reduction of the fracture.

The linkage mechanism 318 can comprise, e.g., a ball-and-socket joint, ahinge joint, a clevis joint, an axial joint, a universal joint, aspherical plain bearing, a multi-bar linkage, a spatial linkage, aspherical linkage, or a combination or combinations thereof. The linkagemechanism permits the respective brace component to be pivoted on thestrut 316 (see FIG. 42A) as well as rocked and swung about the strut 316(see FIG. 42B).

The second orthotic brace 310 can also include another brace component322 interacting with at least one of the proximal and distal bracecomponents 312/314.

The second orthotic brace 310 is sized and configured to be fully orpartially assembled and fitted to a bone region having a fracture priorto, during, or after fracture reduction and fixing. The second orthoticbrace 310 helps to maintain and/or improve the reduction, after fixing,while healing occurs. The second orthotic brace 310 performs thisfunction by controlling, guiding, limiting and/or immobilizing thereduction after fixing; and/or restricting movement in a givendirection; and/or reducing weight bearing forces; and/or otherwisemaintain the orientation of the bone structures after reduction andfixing.

The second orthotic brace 310 and associated systems and methods thatwill be described are applicable to all bone fractures, simple orcomplex, in children or adults, and involving all bone types, including,e.g., in the arm, involving the humerus and/or forearm and/or wrist; inthe leg, involving the tibia and/or fibula; and at, in, or neararticulating condyles (also called a condular fracture), e.g. at, in, ornear the elbow, or at, in, or near the knee. Still, as before explainedin the context of previous descriptions, the technical features of theorthotic brace 310 and associated systems and methods can be wellexemplified and highlighted with respect to the fixing of supracondylarfractures of the elbow. For this reason, a structural implementation ofthe second orthotic brace 310 and associated systems, and methods willbe described in this context. Nevertheless, it is to be appreciated thatthe orthotic brace 310 and associated systems and methods that embodyfeatures of the invention are not restricted to supracondylarapplications. It is to be appreciated that the disclosed second orthoticbrace 310 and associated systems and methods are readily applicable foruse in treating all types of bone fractures, simple or complex, of anybone type, in children or adults, anywhere in the body.

In this context, the second orthotic brace 310 includes a proximalhumeral brace component 312 and a distal radius/ulnar brace component314. The humeral brace component 312 and the radius/ulnar brace 314component are preferably formed of open cylindrical structures forreceiving a region of the respective humerus and the radius/ulna,respectively. The use of straps and other devices to retain thefractured arm, as discussed above, could also be used with the secondorthotic brace 310.

In the illustrated structural implementation (FIGS. 39 and 40), thestrut 316 is connected by a ball-and-socket joint 318 to the humeralbrace component 312 and by another, separate and independentball-and-socket joint 312 to the radius/ulnar brace component 314. AsFIGS. 42A, 42B, and 42C show, the separate and independentball-and-socket joints 312 allow independent articulation of the humeralbrace component 312 and/or the radius/ulnar brace component 314 within arange of rotational orientations to accommodate traction, translation,flexure/extension, pronation/supination, and varus/valgus rotationalforces applied to reduce the fracture, as shown by the directionalarrows in FIGS. 42A and 42B.

The humeral brace component 312 can be pivoted on its ball-and-socketjoint 318 on the strut 316 within a range of rotational orientations(see FIG. 42A) and/or swung and/or rocked on its ball-and-socket joint318 within a range of rotational orientations about the strut 316 (seeFIG. 42B), including, within the ranges of articulation an infinitenumber of intermediate rotation orientations and combinations ofrotational orientations.

Independent of the orientation of the humeral brace component 312, theradius/ulnar brace component 314 can likewise be freely pivoted on itsball-and-socket joint 318 on the strut 316 within a range of rotationalorientations (see FIG. 42A) and/or swung and/or rocked on itsball-and-socket joint 318 within a range of rotational orientationsabout the strut 316 (see FIG. 42B), including, within the ranges ofarticulation an infinite number of intermediate rotation orientationsand combinations of rotational orientations.

In the illustrated structural implementation (see FIG. 42C), a lockingpin 320, e.g., with a hex bolt or allen wrench fitting, is operativelycoupled to each ball-and-socket joint 318. Each locking pin 320 can beloosened, e.g., by counterclockwise rotation, to free articulation ofthe respective ball-and-socket joint 318. Conversely, each locking pin320 can be tightened, e.g., by clockwise rotation, to frictionallyprevent articulation of the respective ball-and-socket joint 318, andthereby maintain the desired angular orientation of the respective bracecomponent 312/314, to allow for proper positioning of the secondorthotic brace 310 on the reduced fracture.

Desirably, as is shown in the illustrated structural implementation (seeFIG. 43), the strut 316 includes an axial mechanism 324 providingelongation or shortening of the axial distance between the proximal anddistal brace components 312/314 independent of the linkage mechanism 318just described, including a locking mechanism 326 to maintain a desiredaxial distance.

In the illustrated structural implementation, the axial mechanism 324includes, e.g., telescoping strut arms. The telescoping strut arms 324can be axially moved together or apart (as shown by directional arrowsin FIG. 43, to mutually shorten or lengthen the separation between thehumeral brace component 312 and the radius/ulnar brace component 314.

In the illustrated structural implementation, a locking pin 326, e.g.,with a hex bolt or allen wrench fitting, is operatively coupled to thetelescoping strut arms 324. The locking pin 326 can be loosened, e.g.,by counterclockwise rotation, to allow the sliding of the strut arms 324apart or together. Conversely, the locking pin 326 can be tightened,e.g., by clockwise rotation, to frictionally prevent the sliding andthereby maintain the desired separation between the brace components312/314, to further allow for proper positioning of the second orthoticbrace 310 on the reduced fracture.

In the exemplary structural implementation for use on a supracondylarfracture (see also FIG. 41), the radius/ulnar component 314 furthercomprises a carpal brace component 322 coupled to the radius/ulnar bracecomponent by a second strut 328. As FIG. 41 shows, the carpal bracecomponent 322 is sized and configured to be fitted to a wrist region ofthe supracondylar fracture.

The second strut 328 establishes a spacing distance between the distalbrace component 314 and the carpal brace component 322. The second strut328 slides within a channels 330 in the distal brace component 314 andthe additional brace component 322, which provides for elongation orshortening of the spacing distance.

A locking mechanism 332 is provided to maintain a desired spacingdistance, to be properly sized to a particular individual. In theillustrated implementation, fasteners, e.g., screws or bolts, on thestrut 328 can be loosened, e.g., by counterclockwise rotation, to allowthe strut 328 to slide along the channels 330, thereby adjusting theseparation between the carpal brace component 322 and the radius/ulnarbrace component 314. The fasteners 332 can be tightened, e.g., byclockwise rotation, to frictionally prevent sliding of the strut 328within the channels 330, to thereby to maintain a desired separation,once achieved.

As FIGS. 44A to 44C show, the second orthotic brace 310 can be sized andconfigured to be component part of a mechanical fracture reductionfixture 14, to accommodate temporary securing of the orthotic brace 310to a humeral support carriage 26 and a radius/ulna support carriage 28,either fully or partially assembled to a region of fractured bone, tothereby reside on the fixture 14 while mechanical reduction is achievedand/or reside on the fixture 14 while mechanical reduction fixing isachieved. The second orthotic brace 310 includes the flexibility torespond to translational and rotational forces applied to the fracturewhen attached to the humeral support carriage 26 and the radius/ulnasupport carriage 28 of the fixture 14.

As shown in FIGS. 44A to 44C, this aspect of the invention thereforeprovides a mechanical bone fracture reduction system 334 comprising theframe 22 (as previously described) that is sized and configured tosupport a bone fracture and the mechanical reduction mechanism 16 (aspreviously described) on the frame 22 that is sized and configured toapply to the bone fracture a mechanical force vector that moves the bonefracture into a desired anatomic orientation. The mechanical reductionmechanism 16 includes one or more locking mechanisms (as previouslydescribed) that are sized and configured to mechanically interact withthe reduction mechanism 16 to maintain the desired anatomic orientation.The system 10 includes an orthotic brace 310 that is sized andconfigured to be fitted to a region of the bone fracture before, during,or after the reduction of the fracture by the reduction mechanism. Theorthotic brace 310 includes a proximal brace component 312 that is sizedand configured to be fitted to a proximal region of the fracture, adistal brace component 314 that is sized and configured to be fitted toa distal region of the fracture, and a strut 316 having a proximalregion linked to the proximal brace component 312 and a distal regionlinked to the distal brace component 314. At least one of the proximaland distal regions comprises a linkage mechanism 318 permittingarticulation of the respective brace component on the strut 316 within arange of rotational orientations in response to forces applied by thereduction mechanism. The respective region further includes a lockingmechanism 320 to maintain a desired rotational orientation within therange to maintain the desired anatomic orientation.

The frame 22 can also carry a mechanical guidance mechanism 18 (aspreviously described) that is sized and configured to guide placement ofone or more bone fixing devices 202 to maintain the desired anatomicorientation.

After reduction and/or fixing of the fracture (see FIG. 45), the secondorthotic brace 310 is sized and configured to be removed from thefracture reduction mechanism 16 and thereafter worn by the individual,fully assembled to the fixed reduction, to maintain and/or improve thefixed reduction while healing occurs. For example, the technicalfeatures of the second orthotic brace 310 as described make it possiblefor the brace to adapt to the mechanical reduction forces applied by theexemplary fracture reduction mechanism 18 when reducing and fixing thefracture (see FIG. 44A). As previously demonstrated in FIGS. 41, 42, and43, when attached to the exemplary fracture reduction mechanism 18 (asshown in FIG. 44A), the second orthotic brace 310 accommodates theindependent application of all the mechanical force reduction vectorsalong and about all three anatomical reduction axes of the arm aspreviously described; namely, the ARPA, ARVA, and ARHA (shown in FIG.12A). The strut 306 with the independent axial adjustment mechanism 324and linkage mechanism 318 connected to each of the humeral bracecomponent 312 and the radius/ulnar brace component 314 allows the bracecomponents 312/314 to be manipulated independently when attached to thefracture reduction mechanism 18. The second orthotic brace 310 adapts tothe myriad adjustments of the fracture reduction mechanism 18 whenreducing and fixing the fracture.

More particularly, as shown in FIG. 44A, the exemplary fracturereduction mechanism 18 previously described (also see e.g. FIGS. 19A and19B) includes a humeral support carriage 26 and a radius/ulna supportcarriage 28. The humeral support carriage 26 and radius/ulna supportcarriage 28 can be sized and configured to be temporarily secured to thehumeral brace component 312 and the radius/ulna brace component 314 ofthe orthotic brace 310. In this arrangement, the humeral supportcarriage 26 and the radius/ulna support carriage 28 hold the humerus andradius/ulna within the orthotic brace 310 in the same orientation duringmechanical reduction, and maintain this orientation after reductionduring mechanical fixing of the reduction.

It can be appreciation that the form, fit, and function of the humeralbrace component 312 and the radial/ulnar brace component 314 complementthe form, fit, and function of the humeral support carriage 26 and theradius/ulna support carriage 28 of the mechanical reduction frame. Forthis reason, the second orthotic brace 310 can be sized and configuredto be partially or fully assembled to the individual's arm and betemporarily secured, e.g., by straps, pins, or fasteners, to the humeralsupport carriage 26 and the radius/ulna support carriage 28 of thereduction frame prior to mechanical force, as previously described withrespect to the first orthotic brace 300. The orthotic brace 310 canlikewise be sized and configured, while partially or fully assembled tothe individual's arm, to remain secured to the humeral support carriage26 and the radius/ulna support carriage 28 during fixing of the reducedfracture. After fixing of the mechanically reduced mechanism 18, theorthotic brace 310 is released from the system fully assembled to theindividual's arm, to be worn by the individual to maintain and/orimprove the reduction, after fixing, while healing occurs (as shown inFIG. 45).

In the exemplary embodiment shown in FIGS. 44B and 44C, each ofradius/ulna support carriage 28 and the humeral support carriage 26includes an orthotic brace support mechanism 336 carried by therespective carriage 26/28. In the exemplary embodiment, the orthoticbrace support mechanisms 336 for the carriages 24/26 are essentiallyidentical.

Each orthotic brace support mechanism 336 includes female vice flange338 that accommodates placement of a mating male flange 340 formed onthe companion humeral brace component 312 or radius/ulna brace component314. The female vice flange 338 includes a fixed flange member 342 and amovable flange member 344. The movable flange member 344 is secured by athreaded pin 346 opposite from the fixed flange member 342.

Rotation of the threaded pin 346 in one direction retracts the movableflange member 344 away from the fixed flange member 342 (see FIG. 44B).This enlarges the width of the female vice flange 338 to a dimensionlarger than the male flange 340, so that the male flange 340 can befitted into the female vice flange 338. This, in turn, fits thecompanion brace component 312/314 to the respective carrier 26/28.

Rotation of the threaded pin 346 in the opposite direction advances themovable flange member 344 toward the fixed flange member 342 (see FIG.44C). This reduces the width of the female vice flange 338 tofractionally engage the male flange 340 previously fitted into thefemale vice flange 338. This secures the male flange 340 by frictionalengagement within the female vice flange 338. The companion bracecomponent 312/314 is also thereby secured to the carriage 26/28. Thecompanion brace component 312/314 thereby functions In this arrangement,the humerus support carriage 26 and the radius/ulna support carriage 28comprise a mechanical component of the fracture reduction fixture 14,carried by the frame 22, and a removable component, i.e., the companionbrace component 312/314 carried by the ambulatory orthotic brace 310.

The locking pins 320 and 326 on the strut 316 of the orthotic brace 310are loosened (either before or after fitment on the respective carriage26/28). This allows unimpeded articulation and axial separation of thehumeral brace component 312 and the radius ulna brace component 314while the mechanical force reduction assemblies of the fracturereduction mechanism 16 orient the humeral support carriage 26 and/or theradius/ulna support carriage 28 in a stepwise fashion to reduce thefracture.

Once the fracture has been mechanically reduced (and desirably fixed) bythe mechanisms 16/18, the locking pins 320 and 326 on the strut 316 ofthe orthotic brace 310 are tightened to maintain and/or improve themechanically achieved reduction and (if performed) fixing. The threadedpin 346 on each orthotic brace support mechanism is rotated to retractthe movable flange member 344 away from the fixed flange member 342 (seeFIG. 44B), to enlarge the width of the female vice flange 338, so thatthe respective orthotic brace component 312/314 can be removed fromcompanion carrier 26/28.

As shown in FIG. 45, the individual wears the orthotic brace 310 whilepost-operative healing occurs. The orthotic brace 310 is now ambulatory.The ambulatory brace, oriented as a result of mechanical reductionforces applied in a stepwise systematic manner, serves to maintain theorientation of the bone structures after reduction and fixing as healingoccurs.

VII. Methods of Mechanically Reducing and Fixing a Bone Fracture

A. Overview

Illustrative devices and systems for achieving a mechanical forcereduction and fixing of a fracture have been described, for the purposeof illustration, in the context of reducing a supracondylar fracture.Next to be described are illustrative methods for mechanically reducingand fixing a fracture using the exemplary devices and systems.

The methods that will be described are applicable to all bone fractures,simple or complex, in children or adults, and involving all bone types,including, e.g., in the arm, involving the humerus and/or forearm and/orwrist; in the leg, involving the tibia and/or fibula; and at, in, ornear articulating condyles (also called a condular fracture), e.g. at,in, or near the elbow, or at, in, or near the knee. Still, as beforeexplained in the context of previous descriptions, the technicalfeatures of the methods can be well exemplified and highlighted withrespect to the fixing of supracondylar fractures of the elbow. For thisreason, the methods will be described in this context. Nevertheless, itis to be appreciated that the methods that embody features of theinvention are not restricted to supracondylar applications. It is to beappreciated that the disclosed methods are readily applicable for use intreating all types of bone fractures, simple or complex, of any bonetype, in children or adults, anywhere in the body.

In this context, and as shown in FIG. 48, the individual having asupracondylar fracture to be treated in their right arm is laid in asupine position on a patient platform 12, upon which a fracturereduction fixture 14 like that shown in FIGS. 19A and 19B is supported.Together, the patient platform 12 and the fracture reduction fixture 14form the system 10.

The directional points of reference (Support Side, Free Side, Left,Right, Top, and Bottom), as used previously in FIGS. 18A/B to define theorientation of the system, annotate FIG. 48. Laying supine, theindividual's anatomic anterior side faces Top-ward, and the individual'sanatomic posterior side faces Bottom-ward. The individual's head (theanatomic superior or cephalad direction) faces Left-ward. Theindividual's feet (the anatomic inferior or caudal direction) facesRight-ward. For treatment of a right arm, the mount 20 is Support-ward,adjacent the individual's right arm side (the anatomic right lateraldirection). The individual's other side (the anatomic left lateraldirection) faces Free-ward. This orientation is also shown in FIG. 18C.It should be appreciated that, for treatment of a left arm, theindividual's head (the anatomic superior or cephalad direction) facesRight-ward, and the individual's feet (the anatomic inferior or caudaldirection) faces Left-ward (as shown in FIG. 18D). Thus, it can be seenhow the structural directional points of reference in FIGS. 18A/B can bereadily converted to anatomic direction points of reference relative tothe individual being treated, if desired.

For the sake of consistency, subsequent description will continue to usethe structural directional points of reference (Support Side, Free Side,Left, Right, Top, and Bottom) used in FIGS. 18A/B.

The individual's right arm is oriented with the humeral support carriage26 and a radius/ulna support carriage 28 of the fracture reductionfixture 14. In the exemplary embodiment (see FIG. 49), the orthoticbrace 310 is either fully or partially assembled on the arm andtemporarily secured to the humeral brace component 312 and aradius/ulnar brace component 314, as previously described.

B. Pre-Procedure Alignment

Prior to beginning the procedure, the fracture reduction fixture 14 ismounted to the patient platform for use. The components of the fracturereduction fixture 14 are placed in their neutral, or rest, positions.For the horizontal traction carriage 42 (see FIG. 44A), the restposition is fully translated over to the Support Side of the horizontalrail. For the vertical traction carriage 54 (see FIG. 44A), the restposition is fully translated over to the Bottom of the vertical rail 56.For the lateral translation carriage 64, the rest position istranslating the support bed 66 to the middle of the cross bar and theparallel companion threaded cross bolt. For the rocking carriage 74, therotation carriage, and the tilting carriage, the rest position islikewise in their centermost, neutral positions parallel to theMechanical Axes of the fracture reduction fixture 14.

During the reduction procedure, the c-arm 272 can be oriented relativeto the supracondylar region for lateral and a-p radiographic imaging ofthe supracondylar fracture, as shown, respectively, in FIGS. 46A and47A. FIG. 46B shows a lateral image of the displaced distal and proximalbone regions of supracondylar fracture of a right arm, prior toreduction. FIG. 47B shows a lateral image of the displaced distal andproximal bone regions of supracondylar fracture of a right arm, prior toreduction.

The caregiver or surgeon uses a-p and lateral radiographic images toinitially align the fractured supracondylar region carried by thefracture reduction fixture 14 relative to a central point of referenceon the fracture reduction fixture 14, where central Mechanical Verticaland Horizontal Axes intersect (see FIG. 56). The central MechanicalPerpendicular axis also intersects this point. By aligning the fracturecentrally along these axes by a-p radiographic imaging and by lateralradiographic imaging, the caregiver or surgeon will also initially alignthe mechanical components of the fixture 14 and orthotic brace 310relative to these points of reference, for further reduction and fixing.FIGS. 50 and 51 illustrate exemplary devices to assist in thisalignment.

FIG. 50 shows an exemplary a-p crosshair device 106. The a-p crosshairdevice 106 generally comprises an elongated body having opposing endsthat are spaced apart so that they will extend across the fixingalignment rail 214 (see FIG. 52). Each of the opposing ends form aflange 108 that allows the a-p crosshair device 106 to sit on thealignment rail 214. The a-p crosshair device 106 further comprises acrosshair section 110 that is centered on the elongated body. Whenspanning the fixing alignment rail 214, the crosshair section 110 alignswith the central Mechanical Vertical Axis of the fracture reductionfixture 14. The a-p crosshair device 106 is made of a radioluminescentmaterial so that, during a-p radiographic imaging (see FIG. 53), thecrosshair section 110 radiographically identifies the location of thecentral Mechanical Vertical Axes of the fraction reduction fixture 14.The circular geometry of the alignment rail 214 ensures that the centralcrosshair section 110 will always be centered on the center MechanicalVertical Axis of the fracture reduction fixture 14, regardless of wherethe crosshair device 106 is placed across the fixing alignment rail 214.

FIG. 51 depicts a lateral crosshair device 112. The lateral crosshairdevice 112 includes proximal and medial mounts 114 and a distal openingforming a crosshair section 116. The lateral crosshair device 112 issized and configured so that the proximal and medial mounts 114 engagevertically aligned pins 118 formed on the horizontal top bar 98A and ahorizontal bottom bar 98B of the second parallelogram 98 of theflexion/extension rotation mechanical force reduction assembly 40 (seeFIG. 54). Engaged by the pins 118, the cross hair section 116 hangsbelow the second parallelogram 98 aligned with the central MechanicalHorizontal Axis of the fraction reduction fixture 14. The lateralcrosshair device 112 is made of a radioluminescent material so that,during lateral radiographic imaging (see FIG. 55), the crosshair section116 radiographically identifies the location of the central MechanicalHorizontal Axes of the fraction reduction fixture 14.

In use, the components of the fracture reduction fixture 14 are placedin their neutral, or rest, positions (as previously described). Thehumerus and radius/ulna (held by the orthotic brace 310, if desired) aresecured to the fracture reduction fixture 14, respectively, on thehumeral support carriage 26 and the radius/ulna support carriage 28. Thea-p crosshair device 106 and the lateral cross hair device 112 areplaced on the fracture reduction fixture 14 (see FIGS. 54 and 56).

Using a-p radiograph imaging and the a-p crosshair device, thehorizontal traction carriage 42 and lateral translation carriage 64 aremoved to initially align the center of the fracture (viewed a-p) withthe crosshair section 110 of the a-p crosshair device (see FIG. 53).This initial a-p alignment is maintained using the control mechanismsprevious described.

Using lateral radiograph imaging and the lateral crosshair device 112,the vertical traction carriage 54 is moved to initially align the centerof the fracture (viewed laterally) with the crosshair section 116 of thelateral crosshair device 112 (see FIG. 55). This initial laterallyaligned position is maintained using the control mechanisms previousdescribed.

As shown in FIG. 56, the alignment of the axis of the a-p crosshair 110and the lateral crosshair 116 intersect perpendicularly to one another,and centrally align the fracture reduction fixture 14 and the fracturerelative to these coordinates. Once aligned with one another, thecaregiver or surgeon can remove the a-p and lateral crosshair devices106 and 112 and proceed with the reduction and fixing processes.

C. Mechanically Achieving Distal Traction

As FIGS. 57 to 59 show, the caregiver or surgeon operates the distaltraction mechanical force reduction assembly 30, as previouslydescribed, to move the radius/ulna support carriage 28 in a Free-wardpath in the horizontal plane (refer back to FIG. 20A). The humeralsupport carriage 26 remains stationary during Free-ward translation ofthe radius/ulna support carriage 28. Aided by lateral radiographicimaging (as FIGS. 57 and 58 show), the caregiver or surgeon mechanicallyapplies linear Free-ward translation in a controlled fashion to move theradius/ulna support carriage 28 in a linear path Free-ward, laterallyfarther from the humeral support carriage 26. The distal tractionmechanical force reduction assembly 30 mechanically achieves distaltraction along the ARPA of the fracture reduction coordinate system ofthe supracondylar region (refer back to FIG. 12A), by separating thedistal bone region and the proximal bone region along the ARPA (asconfirmed by the lateral radiographic imaging shown in FIGS. 60 and 61),until a desired alignment in this first anatomic orientation isachieved. The caregiver or surgeon mechanically maintains the desiredalignment in the first anatomic orientation, as previously described.

D. Mechanically Achieving Superior Traction

As FIG. 62 shows, the caregiver or surgeon operates the superiortraction mechanical force reduction assembly 32, as previouslydescribed, to move the radius/ulna support carriage 28 in a linearTop-ward path in the vertical plane (refer back to FIG. 21A). Thehumeral support carriage 26 remains stationary during Top-wardtranslation of the radius/ulna support carriage 28. Aided by lateralradiographic imaging (as FIG. 63 shows), the caregiver or surgeonmechanically applies linear Top-ward translation in a controlled fashionto move the radius/ulna support carriage 28 in a linear path Top-ward,laterally farther from the humeral support carriage 26. The superiortraction mechanical force reduction assembly 32 mechanically achievessuperior traction along the ARVA (refer back to FIG. 13A) by separatingthe distal bone region and the proximal fracture region along the ARVA(as confirmed by the lateral radiographic image of FIG. 64), until adesired alignment in this second anatomic orientation is achieved.Because the first anatomic orientation is being mechanically maintained,achieving this second anatomic orientation does not alter thefirst-achieved anatomic orientation (in this case, distal traction). Thecaregiver or surgeon mechanically maintains the desired alignment in thesecond anatomic orientation as well, as previously described.

E. Mechanically Achieving Lateral Traction

As FIG. 65 shows, the caregiver or surgeon operates the lateral tractionmechanical force reduction assembly, as previously described, to movethe humeral support carriage 26 in a linear path in a horizontal planein a Right direction (Right-ward) and a Left direction (Left-ward) withrespect to the support platform (refer back to FIG. 22A). Theradius/ulna support carriage 28 remains stationary during linearRight-ward and Left-ward movement of the humeral support carriage 26. Aspreviously explained, in the exemplary embodiment, the Right-ward andLeft-ward translation is achieved in a micro-fashion (as FIG. 65 shows).Aided by a-p radiographic imaging (as FIG. 66 shows), the caregiver orsurgeon mechanically applies linear Right-ward and Left-ward translationin a controlled fashion to move the humeral support carriage 26 in alinear path Right-ward and Left-ward. The superior traction mechanicalforce reduction assembly 32 mechanically achieves lateral traction alongthe ARHA (refer back to FIG. 14A) by mechanically returning proximal anddistal bone regions that have been medially displaced along the ARHAback toward the native state of alignment (as confirmed by the a-pradiographic image of FIG. 67), until a desired alignment in this thirdanatomic orientation is achieved. Because the first and second anatomicorientations are being mechanically maintained, achieving this thirdanatomic orientation does not alter the first- and second-achievedanatomic orientations (in this case, distal traction and superiortraction). The caregiver or surgeon mechanically maintains the desiredalignment in the third anatomic orientation as well, as previouslydescribed.

F. Mechanically Achieving Varus/Valgus Rotation

As FIGS. 68 and 69 show, the caregiver or surgeon operates thevarus/valgus rotation mechanical force reduction assembly 36, aspreviously described, to tilt the radius/ulna carriage Right-wards andLeft-wards (refer back to FIG. 23A). The humeral support carriage 26remains stationary as the radius/ulna carriage tilts Left-wards andRight-wards. As previously explained, in the exemplary embodiment, theFront-ward and Back-ward translation is achieved in a macro-fashion (asFIGS. 68 and 69 show). Aided by a-p radiographic imaging (as FIG. 70shows), the caregiver or surgeon mechanically applies Right-ward andLeft-ward rotations in a controlled fashion to rock the radius/ulnacarriage Right-ward and Left-ward. The varus/valgus rotation mechanicalforce reduction assembly 36 mechanically achieves varus/valgus rotationabout the ARPA (refer back to FIG. 15A) by applying a rotational forcevector (torque) about the ARPA to the fractured end of the distal boneregion (held in the radius/ulna support carriage 28). The varus/valgusrotation force, mechanically applied by the varus/valgus rotationmechanical force reduction assembly 36, pivots the fractured end of thedistal bone region about the longitudinal axis of the proximal boneregion, to return the proximal and distal bone regions, which have beenrotationally displaced due to the fracture, back toward the native stateof alignment (as confirmed by the a-p radiographic image of FIG. 71),until a desired alignment in this fourth anatomic orientation isachieved, at which point the locking mechanism is operated. Because thefirst, second, and third anatomic orientations are being mechanicallymaintained, achieving this fourth anatomic orientation does not alterthe first-, second-, or third-achieved anatomic orientations (in thiscase, distal traction, superior traction, and lateral traction). Thecaregiver or surgeon mechanically maintains the desired alignment in thefourth anatomic orientation as well, as previously described.

G. Mechanically Achieving Pronation/Supination Rotation

As FIG. 72 shows, the caregiver or surgeon operates thepronation/supination rotation mechanical force reduction assembly 38, aspreviously described, to rotate or swing the radius/ulna carriageLeft-ward and Right-ward about the Top-to-Bottom virtual center ofrotation (refer back to FIG. 24C). The humeral support carriage 26remains stationary as the radius/ulna carriage swings Left-wards andRight-wards. As previously explained, in the exemplary embodiment, theRight-ward and Left-ward translation is achieved in a micro-fashion (asFIG. 72 shows). Aided by a-p radiographic imaging (as FIG. 73 shows),the caregiver or surgeon mechanically applies Right-ward and Left-wardrotations in a controlled fashion to swing the radius/ulna carriageRight-ward and Left-ward. The pronation/supination rotation mechanicalforce reduction assembly 38 mechanically achieves pronation/supinationrotation about the ARVA (refer back to FIG. 16A) by swinging theradius/ulna support carriage 28 in an arcuate path in a horizontal planeRight-ward and Left-ward about the Top-to-Bottom virtual center ofrotation axis relative to the stationary humeral support carriage 26. Asthe radius/ulna support carriage 28 swings Right-ward and Left-wardabout the Top-to-Bottom virtual center of rotation axis relative tostationary humeral support carriage 26, a rotational force vector(torque) is applied about the ARVA to the fractured end of the distalbone region (held in the radius/ulna support carriage 28). Thepronation/supination rotation force, mechanically applied by thepronation/supination rotation mechanical force reduction assembly 38,pivots the fractured end of the distal bone region about thelongitudinal axis of distal bone region, back toward the native state ofalignment (as confirmed by a-p radiographic imaging as shown in FIGS. 74and 75), until a desired alignment in this fifth anatomic orientation isachieved, at which time the locking mechanism is actuated. Because thefirst, second, third, and fourth anatomic orientations are beingmechanically maintained, achieving this fifth anatomic orientation doesnot alter the first-, second-, third-, or fourth-achieved anatomicorientations (in this case, distal traction, superior traction, lateraltraction, and varus/valgus rotation). The caregiver or surgeonmechanically maintains the desired alignment in the fifth anatomicorientation as well, as previously described.

H. Mechanically Achieving Flexion/Extension Rotation

As FIGS. 76 and 77 show, the caregiver or surgeon operates theflexion/extension rotation mechanical force reduction assembly 40, aspreviously described, to tilt the radius/ulna support carrier Free-ward(refer back to FIG. 25A). The humeral support carriage 26 remainsstationary as the radius/ulna carriage tilts Free-ward. As previouslyexplained, in the exemplary embodiment, the Free-ward translation isachieved in a macro-fashion (as FIGS. 76 and 77 show). Aided by lateralradiographic imaging (as FIG. 78 shows), the caregiver or surgeonmechanically applies Free-ward rotation in a controlled fashion to swingthe radius/ulna carriage Free-ward. The flexion/extension rotationmechanical force reduction assembly 40 mechanically achievesflexion/extension rotation about the ARHA (refer back to FIG. 17A) bytilting the radius/ulna support carriage 28 Free-ward relative to thestationary humeral support carriage 26. As the radius/ulna supportcarriage 28 tilts Free-ward relative to stationary humeral supportcarriage 26, a rotational force vector (torque) is applied about theARHA to the fractured end of the distal bone region (held in theradius/ulna support carriage 28). The flexion/extension rotation force,mechanically applied by the flexion/extension rotation mechanical forcereduction assembly 40, tilts the fractured end of the distal bone regionabout the longitudinal axis of the proximal bone region, to return theproximal and distal bone regions, which have been rotationally displaceddue to the fracture, back toward the native state of alignment (asconfirmed by the lateral radiographic image of FIG. 79), until a desiredalignment in this sixth anatomic orientation is achieved, at which pointthe locking mechanism is actuated. Because the first, second, third,fourth, and fifth anatomic orientations are being mechanicallymaintained, achieving this sixth anatomic orientation does not alter thefirst-, second-, third-, fourth-, or fifth-achieved anatomicorientations (in this case, distal traction, superior traction, lateraltraction, varus/valgus rotation, and pronation/supination rotation). Thecaregiver or surgeon mechanically maintains the desired alignment in thesix anatomic orientation as well, as previously described.

I. Fracture Reduction Review

To summarize, the fracture reduction method, as just described, includes

(i) supporting on a frame a body region having the bone fracture,

(ii) operating a first reduction mechanism on the frame to apply to thebone fracture a first predefined force reduction vector that returns thebone fracture to a corrective alignment in a first anatomic orientation,

(iii) mechanically maintaining the corrective alignment in the firstanatomic orientation,

(iv) independent of (ii) and (iii), operating a second reductionmechanism on the frame to apply a second predefined force reductionvector that returns the bone fracture to a corrective alignment in asecond anatomic orientation different than the first anatomicorientation without altering the corrective alignment in the firstanatomic orientation, and

(v) mechanically maintaining the corrective alignment in the secondanatomic orientation.

The force reduction assemblies carried by the system make possible amechanically-achieved complete composite reduction of a complexfracture. In the exemplary case of a supracondylar fracture, the methodcan the operation of up to six force reduction assemblies, correspondingto the up to six mechanical force reductions identified for asupracondylar fracture; namely, (i) a distal traction mechanical forcereduction assembly 30 (ii) a superior traction mechanical forcereduction assembly 32; (iii) a lateral traction mechanical forcereduction assembly; (iv) a varus/valgus rotation mechanical forcereduction assembly 36; (v) a pronation/supination rotation mechanicalforce reduction assembly 38; and (vi) a flexion/extension rotationmechanical force reduction assembly 40.

Reduction can proceed in a systematic, stepwise fashion, by applyingpredefined force reduction vectors one at a time, and mechanicallymaintaining one corrective alignment before proceeding with the next,until alignment in all desired anatomic orientations is achieved.Alternatively, however, the caregiver or surgeon can chose to proceed toapply two or more predefined force reduction vectors concurrently, toachieve concurrent corrective alignments in more than one anatomicorientation at the same time, and mechanically maintaining theconcurrently-achieved corrective alignments. The former, stepwiseapproach is preferred, particularly when the predefined force reductionvectors are applied with manual control and/or guidance. Still, itshould be appreciated that the technical features of the invention canbe achieved without a stepwise approach.

J. Mechanically Achieving Reduction Fixing Guidance

Once mechanical force reduction is achieved, the surgeon or caregivercan, without removal of the orthotic brace 310 and without otherwisealtering the composite reduction mechanically achieved, proceed tooperate a mechanical bone fixing instrument or tool on the fracturereduction fixture 14 like that shown in FIGS. 27 to 35. As shown in FIG.80, by operating the mechanical bone fixing instrument or tool, thecaregiver or surgeon guides insertion of one or more bone fixing devicesto maintain the desired alignment in the anatomic orientations, aspreviously described, and as generally shown for the purpose ofillustration in FIG. 80.

To summarize, the method for mechanically guiding a fixing of a bonefracture reduction comprising

(i) supporting on a frame a body region having bone fracture reduction,

(ii) providing a guide assembly on the frame including a bone fixingdevice guide 208 that defines a guide path along which a bone fixingdevice can be advanced into a region of the reduced bone fracture, theguide assembly including a linkage system that couples the bone fixingdevice guide 208 to the frame for articulation of the guide path among aplurality of desired orientations with respect to the reduced bonefracture,

(iii) mechanically maintaining a desired orientation,

(iv) placing the bone fixing device through the guide into the bonefracture reduction to fix the bone fracture reduction.

In a representative implementation of (ii) and (iii), the linkage systemincludes a first link that articulates the bone fixing device guide 208in a first plane, including a mechanism that is sized and configured tomechanically interact with the first link to maintain a desiredarticulation in the first plane, and a second link that articulates thebone fixing device guide 208 in a second plane different than the firstplane, including a mechanism that is sized and configured tomechanically interact with the second link to maintain a desiredarticulation in the second plane without altering the desiredarticulation in the first plane. In a representative implementation of(ii) and (iii), the linkage system can also include a third link thatarticulates the bone fixing device guide 208 in a third plane thatintersects one of the first and second planes at an angle, including amechanism that is sized and configured to mechanically interact with thethird link to maintain a desired articulation in the third plane withoutaltering the desired articulations in the first and second planes.

Multiple bone fixing devices can be inserted at different articulationsinto the bone fracture reduction.

Desirably, at least one radio-opaque guide is provided parallel to andaxially aligned with the path of the bone fixing device in at least oneof the respective planes. In this arrangement, before placing the bonefixing device through the guide, a radiographic image is generated ofthe radio-opaque guide relative to the bone fracture reduction

As before explained, either the first or second plane can comprise ahorizontal plane, a vertical plane, or a plane that intersects ahorizontal or vertical plane at an angle.

K. Conclusion

Once mechanically guided fixing of the reduced bone fracture isachieved, the orthotic brace 310 can be released from the reductionframe, as FIG. 45 shows, without altering the orientation of bonestructures in the reduced and fixed fracture. The individual is free toambulate as healing occurs and the supracondylar region returns to itsnative state prior to injury.

Each of the mechanical force reduction assemblies is sized andconfigured to independently mechanically manipulate the arm resting inthe humeral support carriage 26 and the radius/ulna support carriage 28.Each mechanical force reduction assembly functions independently of theother mechanical force reduction assemblies, to independently apply andmaintain one of the prescribed mechanical reduction forces to thefracture. Concurrently, the mechanical force reduction assembliesmechanically apply and maintain a plurality of independent mechanicalreduction forces, to thereby mechanically reduce the fracture in thedesired reduction planes.

In the context of reducing a supracondylar fracture, there are sixmechanical force reduction assemblies. The six mechanical forcereduction assemblies correspond to six mechanical force reductionsidentified for a supracondylar fracture. In this context, the mechanicalforce reduction assemblies carried by the support platform comprise (i)a distal traction mechanical force reduction assembly 30; (ii) asuperior traction mechanical force reduction assembly 32; (iii) alateral traction mechanical force reduction assembly; (iv) avarus/valgus rotation mechanical force reduction assembly 36; (v) apronation/supination rotation mechanical force reduction assembly 38;and (vi) a flexion/extension rotation mechanical force reductionassembly 40. Concurrently, the six mechanical force reduction assembliescarried by the system make possible a mechanically-achieved completecomposite reduction of a supracondylar fracture and a mechanicallyguided fixing of the mechanically-achieved complete composite reduction.

L. Robotic/Computer Control

A fracture reduction system comprising one or more mechanical forcereduction assemblies 30, 32, 34, 36, 38, and 40 and/or mechanicalreduction fixing guidance systems 200 can include a robotic/computercontrol system 120 (see FIG. 81). The robotic/computer control system120 includes a remote control console 122 that includes a radiographicimage viewer 124 coupled to the c-arm 272 to facilitate imaging, as wellas one or more instrument drivers 126 coupled by a communication link128 to the mechanical force reduction assemblies 30, 32, 34, 36, 38, and40 and/or mechanical reduction fixing guidance systems 200 carried bythe system 120. The communication link 128 transfers control signalsfrom the instrument drivers 126 to the mechanical force reductionassemblies 30, 32, 34, 36, 38, and 40 and/or mechanical reduction fixingguidance systems 200. The control signals operate the mechanical forcereduction assemblies and/or mechanical reduction fixing guidancemechanisms 30, 32, 34, 36, 38, and 40 in the manners described, underradiographic image guidance. The fracture reduction system 10 comprisinga robotic/computer control system 120 makes it possible to achieve,mechanically and under precise, robotic/computer control, a completecomposite reduction of a fracture and/or a mechanically guided fixing ofa mechanically-achieved complete composite reduction of a fracture.

The foregoing is considered as illustrative only of the principles ofthe invention. Furthermore, since numerous modifications and changeswill readily occur to those skilled in the art, it is not desired tolimit the invention to the exact construction and operation shown anddescribed. While the preferred embodiment has been described, thedetails may be changed without departing from the invention, which isdefined by the claims.

We claim:
 1. A system for fixing a reduced bone fracture comprising aframe that is sized and configured to support a reduced bone fracture ofan individual, a guide assembly on the frame including a bone fixingdevice guide that defines a guide path along which a bone fixing devicecan be advanced into a region of the reduced bone fracture, the guideassembly including a linkage system that couples the bone fixing deviceguide to the frame for articulation of the guide path among a pluralityof desired orientations with respect to the reduced bone fracturewherein the linkage system includes a first link that articulates thebone fixing device guide in a first plane, including a mechanism that issized and configured to mechanically interact with the first link tomaintain a desired articulation in the first plane, and a second linkthat articulates the bone fixing device guide in a second planedifferent than the first plane, including a mechanism that is sized andconfigured to mechanically interact with the second link to maintain adesired articulation in the second plane without altering the desiredarticulation in the first plane, a guide bushing including an interiorchannel for passing a bone fixing device, the guide bushing being sizedand configured to be handled separate from the guide assembly forinsertion into the guide path of the bone fixing device guide at theinstance of use and for separation from the guide path after use, andpackaging that maintains the guide bushing in a sterile condition priorto insertion into the guide path.
 2. A system according to claim 1wherein the interior channel includes an entrance end for receiving thebone fixing device for passage, the entrance end comprising a funnelshaped entrance surface that directs the bone fixing device directlyinto the interior channel, wherein the funnel shaped entrance surfaceshields contact with the interior channel prior to use.
 3. A systemaccording to claim 1 wherein the guide bushing is disposable.
 4. Asystem according to claim 1 wherein the guide bushing can be returned toa sterile condition and repackaged after use.
 5. A system according toclaim 1 wherein the linkage system includes a third link thatarticulates the bone fixing device guide in a third plane thatintersects one of the first and second planes at an angle, including amechanism that is sized and configured to mechanically interact with thethird link to maintain a desired articulation in the third plane withoutaltering the desired articulations in the first and second planes.
 6. Asystem according to claim 1 further including at least one fracturereduction mechanism on the frame that is sized and configured to applyat least one mechanical force vector to maintain the reduced bonefracture in at least one desired anatomic orientation duringarticulation of the guide path of the bone fixing device guide.
 7. Asystem according to claim 1 further including an orthotic brace that issized and configured to be fitted on the frame to a region of thereduced bone fracture.
 8. A system according to claim 1 wherein theframe is sized and configured to support a reduced supracondylarfracture.
 9. A system according to claim 1 wherein the bone fixingdevice comprises a pin.
 10. A method for fixing a reduced bone fracturecomprising providing a frame that is sized and configured to support areduced bone fracture of an individual, providing on the frame a guideassembly including a bone fixing device guide that defines a guide pathalong which a bone fixing device can be advanced into a region of thereduced bone fracture, the guide assembly including a linkage systemthat couples the bone fixing device guide to the frame for articulationof the guide path among a plurality of desired orientations with respectto the reduced bone fracture, articulating of the guide path of the bonefixing device guide into a desired orientation with respect to thereduced bone fracture, providing separate from guide assembly a guidebushing in a sterile condition within a package, the guide bushingincluding an interior channel for passing a bone fixing device, theguide bushing being sized and configured to be handled separate from theguide assembly for insertion into the guide path of the bone fixingdevice guide at the instance of use and for separation from the guidepath after use, either before, during, or after the articulating,removing the guide bushing in a sterile condition from the packaging andinserting the guide bushing in a sterile condition into the guide path,after the articulating, passing a bone fixing device through theinterior channel into a region of the reduced bone fracture to fix thereduced bone fracture, and after fixing the reduced bone fracture,removing the guide bushing from the guide assembly.
 11. A methodaccording to claim 10 after removing the guide bushing, disposing of theguide bushing.
 12. A method according to claim 10 after removing theguide bushing, sterilizing the guide bushing and placing the guidebushing in a sterile condition within a package for reuse.
 13. A methodaccording to claim 10 wherein fixing the reduced bone fracture includesarticulating the guide path into more than one desired orientation and,at each desired orientation, passing a bone fixing device through theinterior channel into a region of the reduced bone fracture to fix thereduced bone fracture.
 14. A method according to claim 10 furtherincluding fitting an orthotic brace to a region of the bone fracturebefore, during or after the fixing.
 15. A method according to claim 10further including before, during, or after the fixing, attaching anorthotic brace to a carrier on the frame in either a partially or fullyassembled condition to a region of the bone fracture, and after fixingthe reduced bone fracture and assembly of the orthotic brace to theregion of the reduced bone fracture, releasing the orthotic brace fromthe carrier, wherein the orthotic brace can be worn by the individual tomaintain and/or improve the fixed reduction while healing occurs.
 16. Amethod according to claim 10 wherein the bone fracture involves an armincluding the humerus and/or forearm and/or wrist; or involves a legincluding the tibia and/or fibula; or involves articulating condylesincluding at, in, or near the elbow, or at, in, or near the knee.
 17. Amethod according to claim 10 wherein the bone fracture comprises asupracondylar fracture.